Bondage and blood thinners
While bondage while on blood thinners is not a concern that's likely to come up too often, it's nevertheless an important issue to be aware of. To define terms, "blood thinners" don't thin the blood in a literal sense. They decrease the formation of blood clots. Blood thinners may be anticoagulant (keeping blood cells from sticking together) or antiplatelet (increasing the time it takes to form a blood clot). They are often prescribed to folks who have medical conditions that put them at increased risk of heart attack or stroke. Blood thinners may be taken temporarily or may be lifelong. There is an increased risk of bleeding (internal and external) when taking blood thinners.[1]
What if you're taking blood thinners and are trying to determine the implications for bondage bottoming or self-tying, or the person you're negotiating a bondage scene with is taking blood thinning medications? To start, consider that many factors contribute to an overall picture of risk – for example, if I'm on blood thinners, am 70 years old with an artificial heart valve, and additionally have an aneurysm (a weakened area in a blood vessel), my risk profile is vastly different from someone on blood thinners who is 30 with no medical history other than a DVT several months ago. My number one piece of advice is to ask your doctor! Being honest with medical professionals is always best. Still, suppose you feel you can't ask your doctor directly about bondage (or that your doctor won’t understand what’s involved in doing rope). In that case, you might ask whether your medications and medical history would preclude you from participating in aerial yoga (including inversions), taking pole dance classes, and/or rock climbing.
It's important to know that blood thinning isn't all or nothing – some medications are mild, some more potent. Medications like ibuprofen, naproxen, and aspirin are relatively mild blood thinners. These medications fall into the NSAID (nonsteroidal anti-inflammatory drug) category. Note that Tylenol (acetaminophen) is not a blood thinner. If someone is taking these medications, the most important consideration is why – the meds themselves are not an exclusion for bondage, but if ibuprofen is being taken for a recently sprained knee, that injury might change your bondage plans. If being taken for ongoing issues like chronic back pain (and unless otherwise recommended by their doctor), I’d suggest that self-tiers or bondage bottoms take ibuprofen instead of aspirin, as the former is not as much of a blood thinner and generally has a lower risk of some side effects.[2]
Next, we move into heavier-duty blood thinners. These medications include warfarin (Coumadin), Plavix (clopidogrel), Pradaxa, and Xarelto (or even injectables like Lovenox). These medications are nothing to fuck with. When you're on these medications, any injury or trauma that might otherwise be negligible can be very serious, even fatal. For example, a relatively minor impact on the head can cause a brain bleed in a person taking strong blood thinners. When patients go on these meds, they are generally advised to avoid risky activities, such as football or skiing. Avoiding "contact sports" is pretty standard advice.[3] Again, you also want to consider the why, as reasons may vary from heart arrhythmias to valve surgery to pulmonary embolism, and these conditions independently have implications for bondage.
Plavix is usually given after someone has a heart attack and has cardiac stents placed. While the medication itself may not be an absolute contraindication for bondage, as always, considering the indications for the drug and overall health is crucial. Specifically, I would want to ask/consider whether the person taking Plavix has been cleared by their doctor for strenuous activity or what type of activity restrictions have been recommended.
Within a serious discussion of risk profiles and the context of understanding a full picture of a person's health, perhaps there could be space for someone on potent blood thinners to still participate in some types of bondage. Risk mitigation that could be considered to bring this into the risk profiles of those involved would include sticking to floorwork, tying in a laying position (not standing or even kneeling, where there is a risk for falls), using thick, soft bondage material (this may be a time to break out the scarves instead of rope), monitoring even more closely than usual, and in general making the bondage "fluffy" and not strenuous.
Concerning suspension, there are a few aspects to consider. One is that a fall is more likely to have catastrophic consequences for someone on blood thinners, so the suspension stakes are higher in that way. Of course, ideally, drops would never happen...but with blood thinners, the stakes are so high. Minor trauma that someone else might walk away from could fairly easily kill someone on blood thinners.
Another aspect is that rope can cause bruising, and anything that causes bruises will be many times worse if the person is on blood thinners. There is a possibility of forming hematomas (a large collection or pool of blood under the skin) or muscle hematomas (bleeding within a muscle group). The sensitivity to trauma is very high. [4]
Specifically to coumadin, maintaining a therapeutic range (keeping the blood in the "Goldilocks" zone where clot formation is "just right") is very tricky. Unless blood levels were checked that day, it is impossible to know whether someone is in the therapeutic range. They could easily be extremely hyper-anticoagulated and very high risk for extreme bleeding/bruising with even minor trauma.
Then, to reiterate, there's the question of why a person is on blood thinners. These are potent, risky medications, and there's going to be a serious reason. Some would be less relevant to suspension (a DVT 4 months ago), but some very much would be acutely relevant (heart arrhythmia, artificial valve, etc).
My personal risk assessment is that I would not be suspended (or self-suspend) if I was on potent blood thinners, and would not suspend someone who was on them. I wouldn't even do partials. I might consider fluffy, laying position floor rope only. I wouldn't say this is the right decision for everyone – do your research, gather as much information as possible, and make an informed choice.
References:
https://my.clevelandclinic.org/health/treatments/22288-anticoagulants
https://www.drugs.com/medical-answers/difference-between-aspirin-ibuprofen-3508521/
https://www.stoptheclot.org/news/athlete-specific-challenges-and-questions-relating-to-blood-clots
https://onlinelibrary.wiley.com/doi/full/10.1111/jth.13697
