+ Reply to Thread
Results 1 to 8 of 8

Thread: Waran and Diving

  1. #1
    RBW Member bjornaow is an unknown quantity at this point bjornaow's Avatar
    Join Date
    Nov 2005
    Location
    SWEDEN
    Posts
    26

    Waran and Diving

    Hi a question to a doctor if there is anybody here? or anybody who knows!!

    I just wounder if there is some who know if you can still dive when you are using (waran) i think the english word for it is warfarin i have to use it for the rest of my life after a valv operation (heart) 5 weeks ago?

    My own doctors can't give me a anser!

    With best regards

    Björn Qvarnström

  2. #2
    Rob Clemes iratnl will become famous soon enough iratnl will become famous soon enough iratnl will become famous soon enough iratnl will become famous soon enough iratnl's Avatar
    Join Date
    Apr 2006
    Location
    Eastbourne, UK
    Posts
    249
    Apeks Meg

    KISS Sport, Copis Meg

    Re: Waran and Diving

    Quote Originally Posted by bjornaow  View Original Post
    Hi a question to a doctor if there is anybody here? or anybody who knows!!

    I just wounder if there is some who know if you can still dive when you are using (waran) i think the english word for it is warfarin i have to use it for the rest of my life after a valv operation (heart) 5 weeks ago?

    My own doctors can't give me a anser!

    With best regards

    Björn Qvarnström
    I'm no expert, but apart from being used as rat poison; in humans it thins the blood and helps prevent blood clots. I would imagine that since this has the potential to alter blood circulation, it could have an impact on decompression....

    just my tuppence worth

  3. #3
    RBW Member SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ is a jewel in the rough SteveJ's Avatar
    Join Date
    Mar 2006
    Location
    Whitby
    Posts
    220

    Re: Waran and Diving

    There are a number of issues here:

    1. The reason for taking the warfarin. It depends on your cardiovascular fitness and reserve and the underlying damage to your heart. i.e., are there reasons to advise against diving before we consider warfarin. A decision may be based on which valve was replaced, any ventricular dysfunction, heart rhythm and presence of angina etc.

    2. The warfarin itself. By being anticoagulated, you are more at risk of a haemorrhage during a dive. This can range from bleeding nose and sinuses in a mask squeeze to coughing up blood from any form of pulmonary barotrauma.

    3. Decompression sickness can be associated with lowered platelet count which is another risk factor for bleeding. Combined with warfarin there is a theoretical risk of haemorrhage into tissue damaged by a bend.

    4. Other medication taken in conjunction with the warfarin.

    In the UK, it is possible to dive on warfarin with limitations on depth to 20m, no stop diving and tight control on anticoagulation, provided the diver is otherwise fit.

    So, a full assessment would have to be made by an experienced dive medicine doc in conjunction with a cardiology work-up.

    Hope that helps.

    Steve
    Last edited by SteveJ; 11th December 2008 at 21:29.

  4. #4
    RBW Member osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris is a splendid one to behold osiris's Avatar
    Join Date
    Feb 2006
    Location
    Auckland
    Posts
    1,382
    HH INSPO HYBRIB BASTARDISED MK

    KISS/IDA64/72/60/Mk15/Cobra

    Re: Waran and Diving

    Quote Originally Posted by SteveJ  View Original Post
    There are a number of issues here:

    1. The reason for taking the warfarin. It depends on your cardiovascular fitness and reserve and the underlying damage to your heart. i.e., are there reasons to advise against diving before we consider warfarin. A decision may be based on which valve was replaced, any ventricular dysfunction, heart rhythm and presence of angina etc.

    2. The warfarin itself. By being anticoagulated, you are more at risk of a haemorrhage during a dive. This can range from bleeding nose and sinuses in a mask squeeze to coughing up blood from any form of pulmonary barotrauma.

    3. Decompression sickness can be associated with lowered platelet count which is another risk factor for bleeding. Combined with warfarin there is a theoretical risk of haemorrhage into tissue damaged by a bend.

    4. Other medication taken in conjunction with the warfarin.

    In the UK, it is possible to dive on warfarin with limitations on depth to 20m, no stop diving and tight control on anticoagulation, provided the diver is otherwise fit.

    So, a full assessment would have to be made by an experienced dive medicine doc in conjunction with a cardiology work-up.

    Hope that helps.

    Steve
    And look at that Rest of the World medical care for you guys courtesy , all courtesy of the NHS. Actually while we are on the subject, I have lump I'm concerned about, wonder if you'd give me a diagnosis? NZ has a pretty rat shit health system so thought Aunty Liz could help out a bit (in the form of your good self of course)?

  5. #5
    RBW Member Gary68 has a spectacular aura about Gary68 has a spectacular aura about Gary68 has a spectacular aura about Gary68 has a spectacular aura about Gary68 has a spectacular aura about Gary68 has a spectacular aura about Gary68's Avatar
    Join Date
    Nov 2007
    Location
    Gainesville, FL
    Posts
    102

    Re: Waran and Diving

    Steve's info makes sense.

    I was on tiny doeses of Warfarin (1mg) and did about 150 dives while on that dose. Checked with DAN - neither DAN nor my doctors had concern.

    Mostly dives in the 100' depth range but including a few dives to 270'.

    One undeserved hit - on a dive to 270'. Could have been due to tight straps, or cold, or warfarin, or just luck. It was my only bend ever. I'm betting warfarin isn't a DCS preventative at least.

  6. #6
    New Member Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell's Avatar
    Join Date
    May 2005
    Location
    New Zealand
    Posts
    683

    Re: Waran and Diving

    Hello,

    Steve's answer is spot on. Use of warfarin to achieve anticoagulation at a level considered appropriate for a mechanical heart valve has been considered a contraindication to diving for the reasons he describes. The true level of risk implied by anticoagulation in diving has never been measured for obvious reasons. Most of the concerns are theoretical, though this does not mean they are invalid. Indeed, it is highly plausible that a bad outcome in any barotraumatic injury or in spinal DCS will be more likely in a warfarinised diver.

    You have some difficult decisions to make, but diving physicians would not have much choice but to recommend you do not dive. I should point out (though it is probably obvious) that you should not stop your warfarin for the purposes of mitigating risk whilst diving. Moreover, as Steve implies, there are other issues to be resolved, like your cardiac function and overall functional capacity following open heart surgery.

    Though of little use to you at this stage, I should point out that divers who wish to continue diving after valve replacement surgery should factor this issue into any decision making about the choice of tissue vs mechanical valves. Tissue valves do not usually need long term anticoagulation, and (all other factors being equal - which they frequently are not!) they would therefore be a better choice for someone keen to continue diving.

    Warm regards,

    Simon M

  7. #7
    RBW Member bjornaow is an unknown quantity at this point bjornaow's Avatar
    Join Date
    Nov 2005
    Location
    SWEDEN
    Posts
    26

    Re: Waran and Diving

    Quote Originally Posted by Simon Mitchell  View Original Post
    Hello,

    Though of little use to you at this stage, I should point out that divers who wish to continue diving after valve replacement surgery should factor this issue into any decision making about the choice of tissue vs mechanical valves. Tissue valves do not usually need long term anticoagulation, and (all other factors being equal - which they frequently are not!) they would therefore be a better choice for someone keen to continue diving.

    Warm regards,

    Simon M
    Yo are right Simon Tissue valv maybe better but because my age I would have to do the surgery again after 8 to 10 years and i was not looking forward to that, thats way my choice was a mechanical valv.

    Best regards

    Björn Q

  8. #8
    Sic Semper Tyrannis NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER is a splendid one to behold NEDIVER's Avatar
    Join Date
    Jan 2008
    Location
    Live Free or Die
    Posts
    774

    Re: Waran and Diving

    Warfarin is a relatively antiquated medication when the above discussions are dealing with interventional therapy. More common these days are drugs like Plavix when you are dealing with Stints, etc.

    While staying on topic of Warfarin, it is all about the INR or international normalized ratio. Patients who are hanging out in these Coumadin Clinics, are in pretty rough shape and are constantly trying to balance the benefits of the drug and the potential of bleeding out. To give you an example of a work up at a clinic I have attached a document that I had on file.

    As far as diving goes, lets look at the medication being the least of the problems, and look at what the patient would present with if they were prescribed Warfarin.

    Common indications are:Venous Thromboembolism (including pulmonary embolism), Atrial Fibrillation, Post-Myocardial Infarction, Mechanical and Bioprosthetic Heart Valves, Recurrent Systemic Embolism.
    What seems to be common of these? Chronic, degenerative and Heart Disease or the risk factor equivalent of.

    Given the reason for dosing one with Warfarin, the question becomes, "Should a patient with Cardiovascular Disease and history of Heart Failure (or the risk equivalent) be participating in a stressful activity where access to medical care is at times hours away, or not adequate to deal with a massive coronary event?"

    From a freedom of choice aspect, do WTH you want. But for a culture that is constantly trying to mitigate catastrophe and unit failures, it would be asinine to have that mind set for a piece of equipment and choose to be cavalier when it comes to our bodies, and the real silent killer... Heart Failure.
    Attached Files
    Last edited by NEDIVER; 13th December 2008 at 01:46. Reason: added document

+ Reply to Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts