I had a follow up appointment with my hematologist last week. Finally my Coumadin level was normal, it took almost a month to get it that way. Coumadin is a blood thinning medicine that is actually a low dose of rat poisoning (according to my Dr., I had no idea) and it is a very time consuming drug to take because it requires constant monitoring to make sure a patient is taking the therapeutic dose. I have been having the INR finger stick test very week to check my levels but once I go back to work, weekly visits are going to be very inconvenient. The other problem with it is that the levels can be knocked out of normal based on a patient’s diet during that week. If you eat too many salads with green leafy veggies (that are very good for you) it can throw off your level and you have to change your dose again. My dose was changed 4 times before it was finally normal. For all of these reasons and more my Doctor is prescribing an entirely new medicine called Xarelto.
Xarelto was originally a medicine to treat atrial fibrillation but has since been found to work for people who have blood clotting problems and has been used for patients therapeutically after hip and knee replacement to prevent embolism (blood clots). After my surgery I was given Lovonox injections for 10 days and I completed that course and ended up with pulmonary embolism anyway.
“XARELTO® is also a prescription medicine used to treat deep vein thrombosis and pulmonary embolism, and to help reduce the risk of these conditions occurring again.”
Medicines that can have adverse interactions with Xarelto:
“Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Some of your other medicines may affect the way XARELTO® works. Certain medicines may increase your risk of bleeding. See “What is the most important information I should know about XARELTO®?”
Especially tell your doctor if you take:
- Ketoconazole (Nizoral®)
- Itraconazole (Onmel™, Sporanox®)
- Ritonavir (Norvir®)
- Lopinavir/ritonavir (Kaletra®)
- Indinavir (Crixivan®)
- Carbamazepine (Carbatrol®, Equetro®, Tegretol®, Tegretol®-XR, Teril™, Epitol®)
- Phenytoin (Dilantin-125®, Dilantin®)
- Phenobarbital (Solfoton™)
- Rifampin (Rifater®, Rifamate®, Rimactane®, Rifadin®)
St. John’s wort (Hypericum perforatum)”
Now that I know all of this I want to know how does it work? Since Coumadin only thins the blood, my doctor said this is different because it doesn’t actually thin the blood it works differently to prevent blood clotting.
“Xarelto tablets contain the active ingredient rivaroxaban, which is a type of medicine called an anti-thrombotic. It is used to stop blood clots forming within the blood vessels. Blood clots usually only form to stop bleeding that has occurred as a result of injury to tissue in the body. The blood clotting process is complicated. When blood begins to clot, a cascade of chemicals is activated within the body, resulting in the formation of an enzyme called thrombin.
Thrombin is central to the complete process of blood clotting. It causes a protein called fibrinogen to be converted into another called fibrin. Fibrin binds blood cells called platelets together, and this forms the blood clot. This is the body’’s natural way of repairing itself.
Sometimes, however, a blood clot can form abnormally within the blood vessels. This is known as a thrombus and can be dangerous because the clot may detach and travel in the bloodstream. The clot may eventually get lodged in a blood vessel, thereby blocking the blood supply to a vital organ such as the heart, brain or lungs. This is known as a thromboembolism. Rivaroxaban is used to prevent and treat these types of blood clots. It works by binding to a substance called factor Xa, which prevents the formation of thrombin. This stops the formation of fibrin, the essential component of blood clots.”
The problem is that the level of this medicine cannot be detected in a patient’s system like Coumadin levels can so my doctor asked me to order a medic alert bracelet so that if I can’t speak for myself emergency technicians will know that I am taking an anti-clotting medication. So I am going on this medicine this week and I feel confident that this will be the best choice for me after doing all of this research and on the advice of my hematologist. I think I will need to be on this or another anti-coagulant medicine for the rest of my life. Since we are not sure medically why I developed such a rare post surgical side effect as multiple pulmonary embolism, to be on the safe side I agreed with my doctor that I should just take this empirically to prevent future events. I have had some genetic blood tests done to see if it is a genetic trait, the preliminary tests were negative but there is still one more result we are waiting for to know for sure. My mother has had a few incidents of pulmonary embolism and has been on coumadin for years as a result.