Thru-Hiking on Blood Thinners: 8 Steps I Took to Hike the AT

I first stumbled across the Appalachian Trail (AT) on a weekend trip to Shenandoah National Park with my friend Alex in the fall of 2017. While hiking in the Hawksbill area, we came to a trail intersection: “Appalachian Trail ← North South →”.

Somewhere deep in the recesses of my brain, I recalled the little knowledge that I did have about the trail. “The Appalachian Trail? Woah… I think I know what this is!!!” I remember an intense, sudden feeling of wonder surrounding the trail. We hadn’t planned on taking the AT as our hiking destination that day, but I felt drawn to walk along it, at least for a little while. “I could hike to Maine from here!!”

From that moment on, I became infatuated with the Appalachian Trail and had a strong feeling that I needed to hike the entire trail someday. I had never felt a calling quite like it. For the next few years, I dreamed of a thru-hike while hiking small sections when I could and saved up money to ensure that I could responsibly commit to a thru-hike financially whenever the opportunity presented itself.

Jump to 2022: Going on Blood Thinners

I had just driven from Pittsburgh to Philadelphia for a friend’s bridal shower in late July. The drive was only about 5 hours long, but after the trip, I started to develop a dull pain in my left calf muscle. It continued for a few days and became progressively worse. Eventually, the pain elevated to the point where I wasn’t able to flex my toes, couldn’t walk without limping heavily, and couldn’t even touch my calf muscle without searing pain running up and down my leg.

I called my older sister (an emergency medicine physician) and she instructed me to get to the emergency room immediately. After a few blood tests, an ultrasound of my leg, and a chest and abdominal CT scan, it was discovered that I had three blood clots in my left leg and a pulmonary embolism in my right lung. I was prescribed the blood thinner Eliquis, was told to stop running (which was my favorite sport and a major de-stressor), and to avoid any dangerous or risky activities where I could fall or bleed.

The Diagnosis

Over the course of the next few weeks, my life continued to feel as though it was falling apart. My Grandma (“Gma,” who also doubled as my best friend) passed away a week later. I was ultimately diagnosed with Factor V Leiden, a genetic blood clotting disorder, which was the root cause of the initial blood clots in my leg and lung.

In addition to this, I was told that I had a tumor on my liver that needed to be checked with further tests, that I needed to see a vascular surgeon about another potential condition that I might have, and I developed yet another blood clot in my leg despite being on preventative medication. I was also balancing working full-time at an engineering company while going to welding school part-time at night. I was feeling overwhelmed with work, school, the seemingly endless hits of bad news, and was in a deep state of grief after my grandma’s passing.

Perfect Time to Hike the AT?

As things began to calm down over the next few months, I began to noodle around with the idea of a 2023 Appalachian Trail thru-hike. I had enough money saved up in my “A.T. Fund” and was finishing school at the end of the year. Because my grandma had passed, I would feel comfortable picking up and leaving home for an extended period of time without worrying something would happen to her while I was away.

However, I wasn’t sure how being on blood thinners would affect my dream of completing a thru-hike. During previous hikes, I had fallen many times and had also gotten plenty of scrapes, cuts, and bruises. On the AT, if something serious happened, I would surely be far from medical help.

C’mon, Google

Fear and apprehension started filling my head. I began talking with doctors and received mixed responses from medical personnel. Some said that I could most likely do it if I was careful, while others strongly discouraged me due to the potential risks. Despite searching the internet intently to find information about thru-hiking with a clotting condition or thru-hiking while on blood thinners, I didn’t find much. I began agonizing over whether or not thru-hiking was irresponsible, and for months went back and forth on the decision.

Ultimately, I decided that putting my dream of thru-hiking on the back burner simply wasn’t an option. I wasn’t going to allow Factor V or being on a blood thinner stop me. I decided that the best thing I could do was to be prepared and take precautions where I could. 

8 Steps I Took to Safely Thru-Hike the AT on Blood Thinners

So, this brings me to the point of this article. I want to provide a starting place for people who may have some of the same questions I had when I was preparing for the AT. Below are the steps that I took to increase my chances of having a safe and successful thru-hike while continuing to take blood thinning medication.

Note: I am not a doctor/medical professional in any way, and this article is intended to speak about my own experiences, not to give medical advice. Make sure you talk to your doctor before taking any of the advice below. 

1. Consulted with my doctors

This is perhaps the most important step you can take. Your doctor will help you understand your condition. Talk through the ins and outs of your hiking plans with your physician. They can tell you about the risks and what unique challenges your condition presents. Ultimately, only I could make the decision to hike or not, but speaking with my doctor let me make an informed decision.

2. Hiked with a trail partner

My trail partner, Victory (non-trail name Heather), and I backpacked the AT’s entire 2,200 miles together. Despite working at the same company for the last 6 years, we only got to know each other a few months before starting our hike in March.

It was extremely comforting to know that I always had someone looking out for me who could potentially call for help if a situation were to become serious. When hiking in front, she made sure to give me a heads up (“Low tree!”) if there was something overhanging the trail or sticking up from the ground that was especially likely to cause me to hit my head or trip me.

It was also very reassuring to our friends and family back home that we weren’t alone. In addition to the ease it brought me from a health perspective, it was also just really fun to be able to share laughter, memories, and misery (at times) with someone else on the trail. 

3. Took my time and hiked cautiously

Victory and I often joked that while every hiker around us seemed to be 6 feet tall, 75% legs, and could float up the trail with ease (the “Gazelle Bubble”), she and I comprised what we referred to as the “Groundhog Bubble.” Not breaking any speed records, we hiked slowly and cautiously knowing that minimizing the number of slips, trips, and falls was critical. During especially treacherous descents, I resorted to “butt-blazing,” or sitting down and scooting my way down the trail.

On most days, we would be some of the first to pack up and hit the trail in the morning, but the last to arrive at the shelter or campsite at the end of the day. Even though consistently putting in longer days was sometimes frustrating (especially in undesirable weather), we knew that we were playing the long game and that taking our time was the key to increasing our chances of getting to Katahdin.

This was true for Victory as well, with or without a bleeding disorder. Overall, I did have 3-4 total falls on the trail. Luckily, I had enough control to make sure that I kept my head up and off the ground or nearby rocks.

4. Carried an emergency SOS/GPS

This one was a no-brainer for me. Many hikers, with medical conditions or not, choose to hike with an emergency SOS/GPS clipped to their packs. If an emergency occurs on trail, the SOS feature provides your GPS coordinates and connects you with the local emergency response team.

I brought along my Garmin InReach Explorer+, but there are lighter-weight options out there too. The Garmin InReach Mini2 weighs in at a very reasonable 3.5 ounces. SOS/GPS subscriptions currently start at around $12/month, which is definitely reasonable given the peace of mind it provides. I also enabled the tracking feature on my GPS, which provided an update of my location every 4 hours. My family and friends back home had a lot of fun following along!

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5. Customized my first aid kit

In addition to the usual acetaminophen, ibuprofen, Band-Aids, and blister prevention in the med kit, we also packed QuikClot gauze, and a few extra gauze pads in case of severe bleeding. QuikClot is used by the military, law enforcement, and other emergency responders to stop bleeding faster than normal gauze or other fabrics.

I ordered the small package on Amazon just prior to hitting the trail. It was inexpensive, fit easily into our med kit, and weighed less than an ounce. Thankfully, I didn’t have to use it during the hike. However, it was a convenient and lightweight comfort to have on the trail and may have saved my life in an emergency. 

In retrospect, I would also consider carrying a tourniquet. These can be purchased online and can be life-saving if one were to injure an artery or have severe bleeding in an arm or leg that couldn’t be stopped with pressure alone.

6. Slept with my legs and feet elevated

The blood clots I developed in August were initiated by remaining in the sitting position for an extended period of time. When this occurs, it is easier for blood to pool in the legs and form clots.

It is often difficult to find perfectly flat tent spots on the AT. I would describe many of the spots as being quite “slanty.” Because of this, I was overly cautious when it came to sleeping. I aimed to make sure I was either sleeping on a level plane or my legs were elevated slightly above/at the level of my heart. When we found ourselves camping in a less desirable spot, I made sure to either sleep with my head on the downward slope so that it was easy for blood to flow out of my legs, or to sleep with my head on the upward slope with my legs elevated using my backpack as a prop underneath.

Since I tended to get headaches in the morning when I slept with my head downward, I usually trended towards the latter. While this wasn’t the most comfortable situation, it sure beat getting another clot. Victory and I shared a tent the entire time on the trail – we used the Big Agnes TigerWall UL 2 and it was big enough to fit both of us, and on rainy nights, all of our gear inside.

7. Wore a medical I.D. bracelet

I also wore a medical I.D. bracelet that noted my name, birthday, emergency contact names and numbers, past medical history, and current medications. I’ve noticed that in recent years, ROADiD and other brands have become popular among athletes and outdoor enthusiasts. Some are even quite fashionable!

The one I have is an athletic-style silicon band. I wear this in my “normal life” too, so hiking with it didn’t feel intrusive at all. My bracelet specifically says that I have a history of DVT/PE and that I am on blood thinners, and lists Eliquis. If I were to have a serious fall, this information would be time-critical for emergency personnel. 

8. Planned ahead to get my medication

Last but not least, I knew I would need prescription refills while on the trail. We were very blessed that Victory’s husband Nick (trail name “Headquarters”) visited us at least once a month while we were hiking. He was able to bring the refill of Eliquis down each time he visited, which made this process very convenient.

If having someone physically deliver it to you isn’t feasible, not to worry. You can have someone back home mail it to a nearby trail town. Alternatively, have the prescription filled at a trail town pharmacy and pick it up while hiking through. 

Hiking the AT on Blood Thinners: Worth the Risk?

I would be lying if I said that even with all of these measures, I didn’t have some degree of fear and anxiety the whole time. It’s important to be realistic and the reality is that I was taking a risk by being hours from help. If I had taken a big fall, blow to the head, or developed a new clot, the results could have become very serious and possibly deadly.

However, I continuously monitored my situation for new developments or something that didn’t feel quite right. After taking the above measures, I am grateful that I was able to enjoy my AT thru-hike to the fullest extent. With confidence, I can say that I succeeded with no regrets!

Yes, Worth It!

Victory and I started at Amicalola Falls on March 20, 2023, and summitted Katahdin 5 months, 2 weeks, and 2 days later on September 5th. Thru-hiking the Appalachian Trail was by far one of the best experiences I’ve ever had. When I think about what I would have missed if I had let my fear of hiking while using blood thinners stop me, I am so relieved that I did my research and prepared myself to go on the hike. I feel blessed beyond measure to have gotten to meet such amazing people, immerse myself in the beauty of nature, and challenge myself mentally and physically.

While I am not a medical professional, my hope is that my experience encourages anyone with similar issues to realize that they don’t necessarily have to put their hiking dreams on hold. With these realistic steps, it’s possible to increase the chances of a safe hike.

Happy hiking!

About the Author

Hi there, I’m Mimi (trail name Meadow) and this year I earned the title of “AT Thru-Hiker!” I’m a Penn State alumna, currently live in Pittsburgh, PA, and am always trying – along with my friends and family – to find new, creative, and sometimes goofy ways to have fun outdoors. When I’m not outside, you can find me working as an engineer, spending time with my two sisters, or catering to my spoiled 16-year-old kitty’s every need.