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|Anticoagulants and Diving|
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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.
Drugs, illness or dietary change can also affect the level of blood clotting when taking Coumadin. Aspirin should be avoided when taking Coumadin because aspirin blocks a backup clotting mechanism which depends on the blood platelets, and leaves no protection against bleeding.
There could be an increased hazard of clotting due to constrictive clothing and equipment.
Anti-coagulants represent a 'relative contra-indication' to diving and the decision to dive or not depends to a great extent on your own comfort level.
Some Information about Coumadin
|Adverse Reactions of Warfarin (Coumadin):
Potential adverse reactions to warfarin sodium may include:
Fatal or nonfatal hemorrhage from any tissue or organ: This is a consequence of the anticoagulant effect. The signs, symptoms, and severity will vary according to the location and degree or extent of the bleeding. Hemorrhagic complications may present as paralysis; paresthesia; headache, chest, abdomen, joint, muscule, or other pain; dizziness, shortness of breath, difficult breathing or swallowing; unexplained swelling; weakness; hypotension; or unexplained shock.
Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. Bleeding during anticoagulant therapy does not always correlate with PT/INR .
Bleeding: which occurs when the PT/INR is within the therapeutic range warrants diagnostic investigation since it may unmask a previously unsuspected lesion, e.g., tumor, ulcer, etc.
Necrosis of skin and other tissues.
Adverse reactions reported infrequently include:
reactions, systemic cholesterol microembolization, purple toes
vasculitis, hepatitis, cholestatic hepatic injury, jaundice, elevated
enzymes, fever, dermatitis, including bullous eroptions, urticaria,
Rare events of tracheal or tracheobronchial calcification have been reported in association with long-term warfarin sodium therapy. The clinical significance of this event is unknown.
Priapism has been associated with anticoagulant administration, however, a causal relationship has not been established.
Signs and Symptoms: Suspected or overt abnormal bleeding
of blood in stools or urine, hematuria, excessive menstrual bleeding,
petechiae, excessive bruising or persistent oozing from superficial
are early manifestations of anticoagulation beyond a safe and
Treatment: Excessive anticoagulation, with or without bleeding, may be controlled by discontinuing warfarin sodium therapy and if necessary, by administration of oral or parenteral vitamin K1. (Please see recommendations accompanying vitamin K1preparations prior to use.)
Such use of vitamin K1 reduces response to subsequent
therapy. Patients may return to a pretreatment thrombotic status
the rapid reversal of a prolonged PT/INR .
If minor bleeding progresses to major bleeding, give 5 to
25 mg (rarely
up to 50 mg) parenteral vitamin K1. In emergency situations of severe
clotting factors can be returned to normal by administering 200 to 500
ml of fresh whole blood or fresh frozen plasma, or by giving
A risk of hepatitis and other viral diseases is associated
use of these blood products; Factor IX complex is also associated with
an increased risk of thrombosis. Therefore, these preparations should
used only in exceptional or life-threatening bleeding episodes
Purified Factor IX preparations should not be used because
increase the levels of prothrombin, Factor VII and Factor X which are
depressed along with the levels of Factor IX as a result of warfarin
treatment. Packed red blood cells may also be given if significant
|The effect of Dicoumarol on the bubble-platelet process is interesting; this may be a beneficial effect and could be protective, as is thought of Aspirin. Certainly no one is going to consider using Coumadin as a preventative for decompression illness or any of the other problems caused by breathing inert gases at pressure.|
Ernest Campbell, MD, FACS All Rights Reserved.