Anticoagulant Medication FAQ

Recently my doctor took me off warfarin and prescribed a newer anticoagulant, dabigatran. Are there any concerns regarding scuba diving while taking this medication?
This is a great question and one that is becoming increasingly relevant for many patients. First I would like to address two general issues related to anticoagulants (sometimes referred to as "blood thinners") and diving. The first issue concerns why you were prescribed an anticoagulant in the first place. The range of indications for anticoagulation is wide, from stroke prevention to treatment of deep vein thrombosis (DVT) or pulmonary embolism. Some of these indications have implications for fitness to dive independent of the issues associated with anticoagulation treatment. Make sure to discuss this with your physician before you return to diving.

Second, there are general risks associated with diving while on anticoagulant medications, whether warfarin or one of the new oral anticoagulants (NOACs). The biggest risks are increased likelihood of bleeding and complications from even minor trauma such as ear or sinus barotrauma. There is also a theoretical risk of bleeding into the brain or spinal cord if decompression illness were to occur. Many dive physicians would recommend diving very conservative profiles to minimize this risk and making sure you can equalize your ears without difficulty.

In addition to these general considerations are some specific risks associated with these newer medications such as Xarelto® (rivaroxaban), Pradaxa® (dabigatran) and Eliquis® (apixiban). While there are advantages to taking these medications, such as not needing to monitor blood levels and probably a lower risk of bleeding, there are also disadvantages. The biggest problem is that there is no antidote for these drugs. The effects of traditional anticoagulants like warfarin can be reversed via oral medications such as vitamin K or transfusion of blood products such as fresh frozen plasma. However, these reversal agents are not effective for people taking NOACs (although there are potential drugs in development). Multiple studies have investigated some of the agents used to reverse the effects of warfarin (including activated prothrombin complex concentrates and recombinant factor VIIa [FVIIa]); while these may be used in an emergency or last-ditch effort, they have limited success in reversing any adverse effects of NOACs.

This is important to consider when diving, especially if you'll be traveling to remote locations. You are at an increased risk for bleeding in the event of even minor trauma, and if you do suffer an injury, there is no easy way to stop the bleeding. Finally, many hospitals or clinics in remote locations do not have some of the products that could be used to attempt to stop bleeding in extreme circumstances.

People who take NOACs can still scuba dive, but they should consider the risks described here and the steps that can be taken to mitigate them.
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