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MichiganScott

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I just don't log dives
I am recovering from a foot surgery and just found out I now have a blood clot in my lower leg mid calf, and have been put on blood thinners. Is it safe to dive in this condition? My doctors said they didn't think it would be a problem but they aren't dive medicine guys, so I can't really trust them. I want to ask DAN, but I'm not a "current" member and am not sure how that works.
 
I would still call DAN, just call the non-emergency phone. I doubt they will turn you down even if you're not a member. If they do, please let me know, because I've been a pro member since forever and would like to know what they do in cases like these. Here's the number:

Non-Emergency Medical Questions
1-800-446-2671 or 1-919-684-2948, Mon-Fri, 8:30am-5:00pm (ET)
 
Been on blood thinners for years because of heart condition, pacemaker too. Hasn't affected my diving, 120 dives last year, and my cardiologist isn't concerned about it. Since you will bleed more freely, don't let a shark bite you.
 
I am recovering from a foot surgery and just found out I now have a blood clot in my lower leg mid calf, and have been put on blood thinners. Is it safe to dive in this condition? My doctors said they didn't think it would be a problem but they aren't dive medicine guys, so I can't really trust them. I want to ask DAN, but I'm not a "current" member and am not sure how that works.

I don't believe there is a direct contraindication to diving while on blood thinners. As mentioned above, there a number of divers who do dive successfully on medication. There are questions to ask however to do it safely.

What are the risks of diving on the medication? In the case of blood thinners, the risks include either prolonged bleeding that may be difficult to control or spontaneous bleeding that may occur without warning. If you are on blood thinners for a lower leg DVT, then you may not need to be on the medication for long periods of time. I would ask your doctor how long they feel you need to be on the medication and if it is brief, then I would not dive until you have completed the course. Something to think about. Blood clots in the legs interfere with blood flow returning from the leg. The arterial system takes the blood to the foot, but the clot in the venous sides prevents the blood from returning. This causes the leg to swell. Diving may make the swelling worse, especially if your legs are below your heart when you do so. You should also have your blood thinner medicine levels checked if you are on Coumadin (Warfarin). This will make sure your blood is not "too thin" which increases your risk for spontaneous bleeding. Blood thinners that are given for DVTs are not for the DVTs per se, but to prevent new clots from forming and migrating to your lungs, brain, heart, intestines, etc. Most patients are placed on them for a finite period of time and then discontinued. Having a DVT develop after foot surgery is not uncommon. Chances are your treatment with medication will be brief. Consult your doctor as to the specific time frame.

Your risks for diving on blood thinners depend on the reasons you are on the medication in the first place, the dosage of the medication, and the duration of therapy.
 
Wow, I just called DAN, and they didn't even ask if I was a member, got right thru, and they were very helpful. They gave me a lot of info a bit too much to try to rember all to repeat here, but generally said my Doc's had to be confident the clot was medically stable, and that I had to be cautious as even minor trouble such as equalizing etc. could turn out to be major with blood thinners in my system and I could spontaniously bleed (not fun sounding) and should be more conservative on dives while on the med. and prb should shy away from deco dives. (That's one heck of a run on sentence)

Thanks for responding to my question, thats why I love this board.
 
DAN is a tremendous resource. And your question got a response from Kilili who gave me a much more positive outlook than I thought possible. I wonder what type of thinners are being used. I wonder if there are various degrees of thinning. There is a test called INR which measures the theraputic value of the thinner. If you were on heprin that may be different than warfin.
Just some thoughts.
Good Luck
DP
 


A ScubaBoard Staff Message...

moved to diving medicine..
 
I also expect that you won't be out long on anticoagulants. I'd think a bigger issue is your foot's ability to handle swimming and walking with all the gear.

Post-op anticoagulant therapy is not unusual in orthopedic procedures although much of the literature focuses on major surgeries involving the pelvis and lower limbs rather than the ankle or foot. Furthermore, without pre-operative DVT therapy, incidence rates range about 40-60% or higher for the former procedures and 4% or less for the latter. Among the contributors to increased thrombotic risk are surgical materials and drugs, transfusions, complications and technique, and post-op immobility.

Generally in post-surgery situations, low-molecular weight heparin (LMWH) anticoagulants (e.g. enoxaparin) are preferred because these have lower bleeding risk than "regular" anticoagulants and, although an injection is involved, can be administered on an out-patient basis. For major orthopedic procedures, the usual course of LMWH anticoagulants is a week to 12 days. Followup, usually oral non-LMWH, anticoagulants could be prescribed for possibly weeks or months, especially when there's persistent immobility or other risk factors for DVT. Oral LMWH preparations have had a spotty record (e.g. ximelagatran) but quite recently, newer formulas have been grinding toward FDA approval (e.g. rivaroxaban).

Along with platelets, immediate measures for clotting status are PT (prothrombin) and PTT (partial thromboplastin time) rates. (There's a ton of other blood components, proteins, and minerals which support clotting but these two are basic indicators.) INR (International Normalised Ratio) is a calculated measure of clotting time, based on a patient's baseline PT. Generally, desired normal values are in the range of 10-13sec for PT, 25-40sec for PTT, and while under anticoagulant therapy, 2-3 for INR (i.e. double or triple PT times above baseline).
 
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