Temporarily stopping Rivaroxaban?
Posted , 3 users are following.
Hi and sorry for not doing the normal introductions as I need guidance relatively quickly. This concerns a relative who's currently 84 years old and has Pakinson's although this is very, very well controlled. She does not suffer dementia of any form.
My relative was given 15 mg daily (twice daily?) dosage of Rivaroxaban back in 2013 to deal with two pulmonary embolism at the time, which may have formed during a second knee replacement before moving to her lungs. This was reduced to 10 mg daily on discharge from hospital to prevent further clots and at the time the treatment was successful.
She was almost diagnosed with COPD at that time until a senior consultant observed that given it was 12 years since her (now late) husband gave up smoking, more severe symptoms would have shown up. The specialist did comment on slightly lower than normal oxygen saturation, which could be attributed to the non-functioning of the lower lobe in the right lung (this may go back many, many, many years).
Fast forward to May of this year and she fell, lascerating her forehead, losing about half a litre of blood. After stitches, she was kept in hospital and her Rivaroxiban was stopped for 7 to 10 days. During this time, she was given a blood transfusion the day following the accident followed by "Ferinject" a few days later for anaemia.
Her Rivaroxaban was restarted once the wound had healed.
Since this time, she had to be readmitted twice for mobility issues (she lost confidence due to the fall) and later, twice for respiratory problems. It's the latter I'm querying.
The current specialist seems to be heading for a COPD-type diagnosis, telling her she now needs access to oxygen at home.
I'll note except for a couple of periods of illness she has not had major issues with breathing up to the fall. Issues seem to have developed afterwards.
My question here is twofold. Firstly, could that period of 7 to 10 days without the Rivaroxaban to encourage the wound to heal, then the blood transfusion then the Ferinject iron supplement caused more clotting?
Secondly, would the restoration of the 10 mg dose be enough to remove any clots or would a higher dose be required.
A further observation since the fall is she's been usually skipping breakfast when she normally takes the Rivaroxaban, to which a pharmacist has commented will not help with the body's uptake of the Rivaroxaban.
I note on her discharge letter for the fall dating back to June that the withdrawal of the Rivaroxaban and the blood transfusion have not been included (an accidental ommission), thus the consultant might not be aware of these potential factors.
Any guidance would be appreciated.
Ian
0 likes, 2 replies
amkoffee Mackem_Beefy
Posted
The idea of the Rivaroxaban is the keep her from getting another clot. They stopped it because her blood was too thin and that's why she bled so much with the head wound. There is a condition that some people have where their blood clouds to much. I can't remeber the name of it but I'm sure you could Google it. I would request that she be tested because it does run in families.
Mackem_Beefy amkoffee
Posted
Cheers,
My relative does take another drug (tradename Securon / Veraspamil) where I think a contraindications is increased likelihood of clotting.
The Rivaroxiban counteracts this effect.
To simplify, my question is would a low dose of Rivaroxiban at 10 mg be enough to dissolve clots formed if she suffered trauma as described (gashed head with a wound of 6 inches, half litre blood loss, followed by blood trasfusion and Ferinject) and for the 7 to 10 days, had to be taken off it?
Ian