Ask general practitioner Maarten: Advice on the use of the blood thinner Xarelto or rivaroxaban.
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I would like your advice on the use of the blood thinner Xarelto or rivaroxaban.
I am a man of 81 years old. Weight 73 kilos, length 190 cm. Do not smoke and do not consume alcohol. My blood pressure is 120/80. The results of my blood test last year were excellent. I like gardening and swimming. Been using extra vitamins for 40 years.
Due to irregular heartbeat since 2009 to Sep. 2015 acenocoumarol used. Successfully underwent an ablation treatment in November 2011. After my stroke in September 2015, on the advice of the cardiologist and neurologist, I switched to Xarelto 20 mg.
No side effects for the first 3 years. Since last year very tired and dizzy, which makes walking unstable, suddenly falling over. Now April 2019 suddenly 2 days of brown colored urine, then 2 days of red and then the color slowly became clear again after a few days.
During the bleeding on your own initiative, do not take Xarelto for 1 day and now take 20 mg instead of 10 mg.
Is this still a safe dose to prevent any clots? Is there a better remedy that causes less side effects?
In the meantime I have been in the Netherlands for a few months. I think it would be wise to make an appointment with the cardiologist and urologist because I also have to urinate frequently with a very weak stream. My fear is that they will start prescribing unnecessary medicines again (it seems that they get a commission on it).
I always faithfully read your advice to other readers and it pleases me that you always weigh the pros and cons of the medication very carefully.
Yours faithfully,
J.
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Dear J,
Few data are available on Xarelto at your age.
You describe that you have had bleeding in the kidneys or bladder. Very wise to lower the dose. Probably also a mild cerebral hemorrhage. An MRI can tell.
Ask your cardiologist if you cannot switch to Pradaxa (dabigatran) in the low dose. Pradaxa seems safer. www.ncbi.nlm.nih.gov/pubmed/30499605 In addition, there is an antidote to Pradaxa.
Incidentally, the question is whether you need to decoagulate.
Sorry for the short answer, but we are in the middle of a move and starting tomorrow I will probably be without internet for a few days.
Sincerely,
Dr. Maarten