This
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Well shit, had my first and hopefully last riding related incident likely exasperated by blood thinners. Went down and landed on my hip on an off-road descent on my hip trying to avoid a hiker and dog. Was quite painful in the moment but kept on riding. A few hours later my hip had swollen to be the size of a bowling ball and went to urgent care who then directed me to ER where they did a full body cat scan to look for other internal bleeding. Everything else was fine, but I feel like the severity of the hematoma on my hip was definitely caused or at least exasperated by the blood thinners.
I’ve fallen before of course and typically just get bruises. This is massive swelling and intense pain due to swelling induced nerve compression. I had already switched down to a lower dose of Xarelto so not sure what more I can do besides ask Hematologist at next visit if there’s any way I can go lower.
I do have a medical ID bracelet now though it was needed in this specific case. When I told them I had crashed while on thinners they still put out a priority alarm in the ER and rushed me to do a cat scan on my brain even though I told them I didn’t hit my head, or barely so at least. I guess better safe than sorry, but I don’t like making a huge fuss over what should have been a very minor crash.
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Glad you are basically OK, other than the hip hematoma.
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I went through a similar thing but after my hip surgery from my crash. Was pretty scary.
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Hello, I was recently diagnosed with two PE’s. I am also on Apixaban. Do you mind me asking what your early healing progression was. I have shortness of breath. I am on 7 days into treatment. Thanks
Hi, my initial treatment plan was 5mg of Apixaban , twice per day. I was told to take 3 months off the bike. I ignored this , i took 6 weeks off the bike and was getting Cabin fever and it was June perfect weather. I did listen to my body. My previous experience with the un-diagnosed clot was my heart rate was low and hitting my FTP was not possible. After the 6 weeks of Apixaban treatment , things appeared okay back on the bike. Able to get back to sweet spot levels and threshold training, i had lost some fitness with the 6 weeks off. I am now on 2.5mg twice daily. Doctor did attempt to stop the Drug and did blood test 6 weeks later, My D-dimer was elevated , hence back on the Apixaban for rest of life.
I should have also stated, Apixaban is not a blood thinner, it competes for blood clotting agent. Hence the clots (PE) are broken down by your bodies process. The Apixaban is meant to stop the clots getting any bigger at your diagnosis phase. Hence your body does need some time to start breaking down the clots. I had dozens of clots in my lungs. As i said six weeks seem to allow a return to training. They also say that moderate exercise helps break the clots down
Thanks I am suppose to do nothing for two weeks. Thanks for the replys, i know very little about this.
As you’ve discovered, there are a few threads on the board on the subject. Highly recommend searching them out and reading them…lots of good info.
Here’s the good news - once you are past the point you are now, things will be fine. It is scary AF right now, I know, especially with your symptoms. But trust the docs and the meds and don’t rush back to activity.
The testing you are undergoing is critical to understanding why the clots occurred. Through testing, I discovered I had Factor V Leiden, which is a genetic mutation that predisposes me to clotting. I am therefore on thinners for life. Again, sounds scary but now isn’t a big deal. Yeah, I mostly gave up racing crits, but I briefly switched to triathlon and now am back to a full-time cyclist and race gravel across the board. Other than popping a pill 2x / day, I don’t even think about it anymore.
Work with your docs, talk to them, make sure they understand your lifestyle when it comes to long-term treatment (if long term is even necessary). Short-term, the thinners have already begun to work on the clots, even if the symptoms persist. Give them some time to do their thing. Focus on recovering, not working out. In the grand scheme of things, a couple of weeks / months is nothing.
Lots of support here on the board…ask questions and someone likely has some feedback for you.
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@Jonathan Do you think there have been enough threads and active enough threads for a segment on clots, thinners and return to training?
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Maybe one on the early stages of PE, what is normal and not normal.
After 7 days i went from 20mg of apixaban to ten, i am not making much breathing headway, still out of breath bad going up and down stairs twice and they are not long. Should i have stayed on the 20. The internal Dr that prescribed them was a locum or traveling Dr.
You should check with your primary doctor and also schedule an appointment with a hematologist. Dosage for Eliquis is a medical question and would not solicit advice for proper dosage here as it is individual. I take 2.5mg 2x daily, so even 10mg seems like a massive amount to me.
Standard of care for apixaban after PE is to do 1 week of 10 mg twice daily, then 5 mg twice daily. 2.5 mg twice daily is what we call “dose-reduced” and is usually done in the setting of older age, poor kidney function, or in a risk/benefit discussion that is patient-dependent. DVT without PE can do 2.5 mg twice daily for extended duration AC…there starts to get nuance and into the art of medicine.
Yeah, I should clarify that I was previously on 5mg daily, but as an active cyclist, I am constantly balancing the risk of a recurrence of a DVT vs. the risk of catastrophic bleed as a result of a crash.
For 10 years, my hematologist kept me on warfarin because there was a readily-available reversal agent and finally moved me to Eliquis 3 or 4 years ago.
He retired last year and my new hematologist agreed to reduce my dosage to 2.5 2x daily to better balance the risk.
All of which underlines your final point…there is nuance and art to good medicine.
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That’s interesting. I’m on 20mg daily of Xarelto/rivaroxaban. I don’t know what dosage that’s equivalent to, but I’d never heard of Eliquis/apixaban, but from a quick Google it seems it’s regarded as safer overall, and clotting times are less affected on apixaban although the half life is longer.
I don’t know that I need to ask my GP about changing, but it’s food for thought.
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