Diving with Factor V Leiden and Anticoagulants

[moseskoko]

I'd like to start by saying hello to all. This is my first post on here.

I've been living with Factor V all of my life, treated since I'm 18, I'm currently 43. Dealing with and working around my blood thinners has become second nature to me. I've always wanted to dive but never pursued it, partially because I wasn't sure if I should. I'd really like to dive. I've always loved the water. Been a strong swimmer since I'm a little boy. I Snorkel and Swim where ever I can. I've Snuba'd a few times as well. Ideally I would eventually pair my love of photography with diving. The key is the diving part. I'm not sure if my doctor is going to sign off to allow me to start a certificate program. I've done some research and read comments but everything is what I expected. Somewhat vague and generally not too helpful. Understandable because only doctors should be making the call.

For that reason I'm not going to ask if I could get certified or if I should pursue diving. My questions are these, Does anyone know someone who has Factor V and dives?? Or knows someone who got certified after they learned they had Factor V? Or knows someone who is taking Anti-coagulants for a Thrombophilic condition that dives??


I have an appointment with my doctor for later in the month. I'm thinking it's a coin flip on whether they sign off or not.

Thank you in advance for any responses.


John

 

[Duke Dive Medicine]

Hi Moses,

We usually advise people who take anticoagulants to avoid diving because of the risk for significant bleeding related to trauma and falls. If the diving takes place far away from advanced medical care there's even more risk.

That said, it may be worthwhile to visit a diving medical practitioner in your area for a more personal evaluation. The closest to you is probably the hyperbaric unit at SUNY.

Best regards,
DDM

 

[TSandM]

I find that strange, DDM. Certainly, anticoagulation raises the risk of bleeding from major injuries, but people can and do engage in a variety of activities while taking anticoagulants. The bleeding risk from minor injuries (if the anticoagulation is properly controlled) usually doesn't pose a threat to life or limb. (I'm talking sprains, closed fractures, bruises, and the like.) The big risk is head injuries, which are relatively uncommon in divers, although possible for anyone who climbing ladders or walking on uneven ground.

I dunno. I'm usually pretty risk averse, but I'd have a hard time telling someone on well-regulated, stable anticoagulation that their medication posed an unacceptable risk for diving.

I just checked the DAN website, and the only entry I could find was in their FAQs, where they simply state that someone taking anticoagulants should be counseled about the increased risk of bleeding from trauma, but they do not say that the medication is a contraindication to diving.

 

[Dr. Doug Ebersole]

I agree with Lynne (TSandM) and also allow patients on anticoagulation to dive as long as they are aware of the increased risk of bleeding in case of trauma. The same goes if they want to ride a bike, go snow-skiing, or any other activity.

 

[moseskoko]

If its a question of "being aware of the potential risks" than I'm pretty comfortable with that. I've heard and dealt with that most of my life. I don't plan on diving below 60'. I've also thought about what would happen if I needed medical attention and I was far from it. I've had to think that through before when I backpacked through Denali and stayed in a remote location in Costa Rica.

Now I guess I'll just wait and see if my doctor will sign off.

Thanks for the advise.

John

 

[tracydr]

I find that strange, DDM. Certainly, anticoagulation raises the risk of bleeding from major injuries, but people can and do engage in a variety of activities while taking anticoagulants. The bleeding risk from minor injuries (if the anticoagulation is properly controlled) usually doesn't pose a threat to life or limb. (I'm talking sprains, closed fractures, bruises, and the like.) The big risk is head injuries, which are relatively uncommon in divers, although possible for anyone who climbing ladders or walking on uneven ground.

I dunno. I'm usually pretty risk averse, but I'd have a hard time telling someone on well-regulated, stable anticoagulation that their medication posed an unacceptable risk for diving.

I just checked the DAN website, and the only entry I could find was in their FAQs, where they simply state that someone taking anticoagulants should be counseled about the increased risk of bleeding from trauma, but they do not say that the medication is a contraindication to diving.

I'm just starting on Coumadin this week, after a prolonged treatment with Lovenox. As a physician, I do understand the risks, particularly with possible head trauma. I've weighed the risks and have decided I will still dive. I will be cautious about boat diving on rough seas, but I'm really keen to take cave classes. And, as we are moving to North Carolina, I do know that you wouldn't be able to keep me away from the wreck diving.

 

[Duke Dive Medicine]

Good points all. Our attendings are pretty well unanimous on this... our concern is for head injury or major trauma. Anyone who chooses to dive on anticoagulants should be well aware of the risks and take steps to mitigate them; it sounds like the OP is pretty well informed but should certainly keep his own safety in the forefront, not only for himself but for those around him who would need to intervene if he's injured. My own personal experience is with a friend who also has factor V Leiden - his care team has advised him not to engage in sports that carry increased risk of bleeding (they include basketball in this, which he is not happy about). That said, there are clearly different opinions on this so hopefully the OP can distill some useful info here.

Best regards,
DDM

 

[moseskoko]

Hello Dr. Tracy. Thank you for sharing your situation. If I may ask, if you had a patient or friend ask you to sign off on their PADI Dive Medical Statement, and they were aware of the risks associated with anticoagulants, would you signed it and mark as "Fit for Diving"?


Most of the cases that I've come across and read, on multiple sites, seem to be cases where people had their certification and then were put on anticoagulants. I haven't come across one where an individual was on anticoagulants and then went to become certified and had the Medical Statement filled out.

John

 

[TSandM]

Interestingly, I just did a very quick literature search for coumadin and head injury. There is one abstract from the Southern Medical Journal that tracked patients evaluated for head injury, with or without coumadin, and found NO difference in any outcome between the groups. Another abstract looked at patients with head injury who were all on coumadin, and all the patients with bad GCS scores or poor outcomes were overanticoagulated. I could not find, but remember reading a study that looked at the likelihood of positive CT in patients in three cohorts -- on Coumadin, on Plavix, and on nothing, and found that the Plavix patients were more likely than the Coumadin patients to have a positive CT, although the likelihood was low in all three groups.

I personally would sign off on a patient if a few things were true: One, the patient had been on a stable dose of Coumadin for at least a few months (thus lowering the likelihood of inadvertent overanticoagulation, which is DEFINITELY dangerous). Two, the patient was reliable and I was confident he or she understood how to manage the anticoagulation properly (eg. the change in INR with antibiotic treatment). Three, we had a discussion about mitigating head trauma risks, such as avoiding boats in heavy weather. I would document that I had advised the patient that there is an increased risk of hemorrhage with trauma, that the patient understood that people with him or her should KNOW about the anticoagulation, and that in the event of physical illness or the institution of any new medications, the patient should not dive until stability of the anticoagulation had once again been established.

I contrast this with spontaneous pneumothorax, where the rate of recurrence is very high -- up to 50% -- and the outcome of the event, should it occur underwater, is highly likely to be lethal. In addition, there are dynamics in diving that make the probability of that particular occurrence higher in that environment. That's a whole different situation, in my view.

 

[Duke Dive Medicine]

Thanks for this post, TSandM, and thanks to all for the discourse. How boring would it be here if everyone always agreed?

Best regards,
DDM