Hi dougsut,
Thank you for your question.
*Note the Important Disclaimer at the bottom of this page.
Please keep in mind that this answer is for information purposes only,
and is not intended to diagnose, treat or replace sound medical advice
from your physician or health care provider. Only your physician will
know what is appropriate for your condition.
With that said, here are the findings I was able to locate for you.
The trouble with warfarin
http://www.divernet.com/medical/0904qanda.shtml
Question:
"I am 34 and on lifelong warfarin because of a genetic predisposition
to deep-vein thrombosis (DVT). Other than this I am very fit and
active, and take part in loads of regular exercises such as climbing
and kung fu. My GP recently passed me on a dive medical, and I have
completed a PADI Open Water course and become hooked. One of the
instructors did however suggest that I ask a dive doctor about the
behaviour of warfarin at pressure. I am aware of the bleeding risks
from injury and can deal with that, but is the action of the drug
itself likely to be affected by recreational diving at 30m or less?"
Answer:
"I regard warfarin as a significant risk in diving. The drug thins the
blood down to prevent clotting and the risk of problems even without
diving is about 2% per year.
There is no data as to how warfarin is affected by pressure but the
main problem occurs with haemorrhage in DCS. If it occurs to someone
on warfarin, severe damage to either the brain or the spinal cord
could occur.
There is also the increased risk of trauma and haemorrhage, but as you
already undertake fairly physical sports this would not be any extra
risk.
Other problems could occur because of barotrauma, with an increased
risk of bleeding into the middle ear with aural barotrauma, or into
the lungs with mild pulmonary barotrauma.
My stance is that divers on warfarin should not dive but this may
change with the introduction of personal tests to detect how thin the
blood is. Testing could be done just before a dive and a decision on
whether to dive or not made on the reading. This would be similar to
diabetics and their blood sugars."
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http://healthlink.mcw.edu/article/989700208.html
"On the other hand, there are other factors which might play a role in
this decision. If your fiance is still taking an anticoagulant to
treat the clot, such as warfarin, he is at risk for bleeding with even
minor injuries. Bumps, scrapes and cuts are common when diving and
many dive outfits discourage patients on these "blood thinners" from
diving."
=========
http://www.scuba-doc.com/antcoag.htm
What Are Anticoagulants?
"Anticoagulants are drugs or substances that cause the blood to clot
more slowly when out of the blood vessel; examples would be coumadin
(Warfarin, Dicoumarol) and heparin. These medications are given
specifically for this effect in order to prevent intravascular
clotting. Other medications have this effect on divers as a specific
side effect; for example, Plavix, aspirin and NSAIDS (ibuprofen),
through their effect on blood platelets, making them
less sticky.
Why is this important to divers?
For divers, the most important question is not whether they are on
blood thinners, but if the condition for which the coumadin is being
used is adverse to diving. Often, the illness is under good control
and does not interfere with safe sport diving. Factors important to
diving with Coumadin depend on the disease process that could be
inimical to diving, how well the clotting time is controlled, careful
clearing techniques to avoid bleeding from ear and sinus barotrauma,
and knowledge of interactions from other drugs and foods which cause
changes in the effects of the anticoagulant.
Divers on blood thinners risk bleeding from injury, ear, sinus and
pulmonary barotrauma. A cut will bleed longer and may require
compression for control; an ear or sinus squeeze will cause excess
bleeding if the squeeze is severe enough to cause damage to blood
vessels in the middle ear, sinuses or lungs. Other medications will
affect the clotting of blood through various mechanisms - including
altering the blood platelets (Plavix, aspirin). Heparin is an
injectable anticoagulant that acts in multiple places in the clotting
schema."
[...]
"Most authorities (Bove, Davis, DAN, etc.) agree that diving with
coumadin is either a relative contra-indication or absolute
contraindication to diving.
The diagnosis of DVT does not in itself constitute a diving danger
(except maybe for the constrictions of gear and wet suits)---but the
bleeding hazards are several. Divers are certainly prone to barotrauma
of the air containing portions of the body (middle ears, sinuses,
lungs, gut) and relatively slight barotrauma can cause significant
bleeding even in the normal diver. Coumadin would certainly aggravate
this occurrence.
Another consideration is the usual relatively small risk for blunt
trauma in scuba diving. This does occur, however, and as is well
known, coumadin is an extremely dangerous drug in this respect. You
only have to have taken care of one giant hematoma to have great
respect for what coumadin can do!
My feeling is that a commercial or rescue diver on coumadin would
place himself and his buddies (and the EMS system) in jeopardy if he
were to participate in diving. He would not be in a position to 'call
his shots' and control his diving but would have to take on all
comers."
=========
http://www.e-med.co.uk/diving/fitness_and_diving.html
Question:
"I have suffered a pneumothorax - 27 years ago. This was as a result
of being immobilised as a result of a car accident. It is thought that
a blood-clot developed in my calf, detached and ended up in my lung. I
was treated with 'Warfarin' for six months. However, I resumed (Army)
sport diving whilst still on medication, and have never suffered any
ill-effect."
Answer:
"The warfarin is an issue if you are still on it. The old rules were
that you were banned from diving if you took this blood thinning
medication. However it is accepted now that the reason not to dive,
that of a potential bleed into your spinal cord on a bend provoking
dive can be safely ruled out by a max depth of 20 metres means that
you can still at least get wet."
=========
http://www.anchovy.durge.org/holiday/Oz/18-8.live
"Thankfully I'm okay to scuba, providing I'm not on Warfarin, which
I'm not. This means I'll dive in the morning, then both of us are
going out."
=========
Best regards,
tlspiegel |
