Xarelto Bleeding Intensity

Xarelto Bleeding Intensity
Feb 24, 2018 5:05pm

George communicated with an acquaintance who experienced Coumadin therapy a few years ago and, subsequent to a new DVT , is now on Xarelto. He notes that minor cuts bleed longer and more profusely when on Xarelto compared to Coumadin. Can any of our subscribers confirm this?

3 Comments

George communicated with an acquaintance who experienced Coumadin therapy a few years ago and, subsequent to a new DVT , is now on Xarelto. He notes that minor cuts bleed longer and more profusely when on Xarelto compared to Coumadin. Can any of our subscribers confirm this?

By Dr. Vadim Kostousov
Feb 27, 2018 5:08pm
Women on rivaroxaban are experiencing prolonged menstrual bleeding, when compared to VKA as shown on slides 10 and 11 on THSNA presentation 2016 from Dr. Shannon M. Bates, "Managing Menstrual Bleeding in Women on Anticoagulants." intuitively, other minor bleeds could be longer. See link http://www.thsna.org/Presentation_Upload/presentation_uploads/16_51_16_51_Managing%20Menstrual%20Bleeding%20in%20Women%20on%20Anticoagulants%20(16-9)_THSNA%202016.pdf
By Dr. Larry Brace
Feb 28, 2018 3:13pm
Though I don't know that many who are taking Xarelto (or any other DOAC), this person's experience seems unusual to me.
By Dr Emmanuel Favaloro
Mar 10, 2018 8:57pm
Any signs of unusual bleeding in a patient on a DOAC should be reported to the patient's doctor; it may mean that Xarelto may not be appropriate for this patient, who may be 'over-sensitive' to Xarelto, and benefit from an alternative DOAC or even potentially a reduced dose of Xarelto. Xarelto has a high hepatic clearance, so if a patient has liver issues, Xarelto may accumulate and lead to bleeding. For this patient, some laboratory testing may help identify if Xarelto is accumulating. see Favaloro EJ, Pasalic L, Curnow J, Lippi G. Laboratory monitoring or measurement of direct oral anticoagulants (DOACs): Advantages, limitations and future challenges. Curr Drug Metab. 2017;18:598–608. Alternatively, consultation with the health care provider may determine if Xarelto is the right anticoagulant for this patient.

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