Warfarin and Diving

A discussion on Warfarin and diving!
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[@gavinsmith28]

Who would you recommend I talk to about alternatives to warfarin for div, given I can dive on warfarin, but the affects on joints and tendons is adverse?

[@DrFJCronje]

Hi Gavin. Thank you for your question. The most important consideration is the underlying reason for taking Warfarin. This addresses the primary risk (underlying cause) and will also assist in identifying potential alternatives. Haematologists are the Medical Specialists dealing specifically with blood-related issues, but -- depending on the reason for taking the warfarin -- it may require input from a cardiologist (if it is due to atrial fibrillation), a pulmonologist (if it is due to pulmonary embolism), a vascular surgeon (if it is due to deep venous thrombosis), and a haematologist if it is due to a familial clotting disorder. I hope this is of some assistance. If you can provide more details on the reasons for taking the Warfarin, we might be able to offer more specific advice. Kind regards, Dr Frans Cronje

[@gavinsmith28]

@@DrFJCronje thanks, it’s haematological

[@ericramosmd]

What about if the treatment is for A Fib?

[@DrFJCronje]

Hi Eric, thank you for your question. The treatment of Warfarin for Atrial Fibrillation would indicate that the atrial size is already 5 cm and that there is a risk of stroke that is serious enough to warrant placing the individual on warfarin. A person with atrial fibrillation also will not have the same tolerance to exercise as a person with upper and lower heart chambers functioning. In short, the warfarin will not be the main consideration in this case. Therefore, a cardiologist would be asked to answer 4 questions: (1) what is the reason for the atrial fibrillation, and does this put the individual at risk of cardiac failure, myocardial infarction or a dangerous arrhythmia; (2) Is the individual at risk for stroke or fainting (syncope); (3) Is the patient's cardiac and rhythm controlled adequately, are the medications for controlling heart rhythm compatible with diving, and does the heart respond appropriately to exertion; and (4) Is the person able to attain 7-9 METS exercise level (or Bruce Treadmill Stage IV) without decompensating. If the answers to these questions are favourable, then the level of Warfarin control can be considered next. As long as the INR (International Normalised Ratio) remains between 1.5 and 2.5 (i.e., the blood clots 50 to 150% less readily than normal blood), warfarin does not impose an undue risk (when considered as a single risk factor). I hope this addresses your question and also demonstrates the principles of risk assessment when dealing with cardiovascular issues. Again, thank you for asking these questions. Then everybody gets a chance to learn -- and that often includes us! 🙂 Kind regards, Dr Frans Cronje

[@DANSouthernAfrica]

Thank you for your response.