surgeons at work

Do you know what adverse reactions your medication might cause? Doctors might prescribe one of the newer anticoagulants such as rivaroxaban (Xarelto) without stressing that there are potentially deadly side effects. That was the tragic outcome for one of our readers.

Xarelto for Atrial Fibrillation:

Q. My husband was on Xarelto for about a year and a half because he had atrial fibrillation. When he had a hernia operation, he stopped taking it for three days but had major internal bleeding afterward. Despite this, his heart specialist continued the prescription.

One day he had some stomach pain and felt faint. We rushed him to the hospital, where he was diagnosed with a ruptured spleen. He had not fallen or bumped himself and there were no bruises on his body. The spleen was removed but the loss of blood could not be stopped because of the Xarelto.

He died one day later. Could the Xarelto have caused the spleen to rupture?

Xarelto Can Cause Severe Bleeding:

A. We are so sorry for your loss. The prescribing information for rivaroxaban (Xarelto) does not specifically mention the spleen, but bleeding into critical organs was reported during clinical trials.

 This anticoagulant is prescribed for people with the abnormal heart rhythm atrial fibrillation. Xarelto should prevent blood clots from forming in the heart and being pumped into the circulation, especially the brain. That protection is important.

Patients must know, however, that this drug can cause dangerous hemorrhage, bleeding around the spinal column and certain blood disorders. Symptoms such as sudden fever, chills, sore throat, mouth ulcers and weakness in arms or legs require immediate medical attention. Excessive bruising or bleeding from cuts and scratches as well as blood in urine or stool also signal a dangerous reaction. Any patient with such symptoms while taking Xarelto should contact the doctor immediately.

What About Warfarin?

Warfarin (Coumadin) was once the drug of choice for atrial fibrillation, but the newer anticoagulants like Xarelto have been embraced by physicians. These more recent drugs don’t require careful monitoring as warfarin does. Indeed, it is not even possible. There is no good way to monitor how well rivaroxaban is working to prevent blood clotting, and physicians still have not worked out practical and quick ways to reverse it in the event of dangerous bleeding (Cardiovascular Therapeutics, April 2014).

Xarelto and other new anticoagulants don’t interact dangerously with foods as warfarin can. That is a selling point. With care, however, patients can avoid serious food-warfarin interactions. We list some of the foods and other drugs that are incompatible with warfarin in our free Guide to Coumadin Interactions.

Revised 1/23/2017

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  1. Stacey
    Dallas, Tx
    Reply

    I was prescribed Xeralto by my cardiologist in Feb 2015 due to Afib. In June 2015 I went to the emergency room because of strong abdominal pain. They said I had a small leak in my large intestine and recommended that I have 1/3 of my intestine removed. They warned me that if I didn’t do it then that the surgery would be much worse done in an emergency situation. I decided to wait. I did a lot of research on it and had a colonoscopy done by another doctor once I got out of the hospital. He helped me to decide not to do the surgery since it is permanent and cannot be undone. I decided I should get off the Xeralto and have not had any problems since then. My Afib was corrected by shocking my heart. I am now very wery of any prescription meds.

  2. Joseph
    Indiana
    Reply

    I also take Xarelto. I am very concerned about the incidents of internal bleeding. When I spoke to my cardiologist he told me there is a 1% chance of bleeding to death. However, a few months ago a had surgery for hemorrhoids and I was told to stop taking Xarelto a few days prior to surgery. I had the surgery with no issues. I was told to continue Xarelto 3 days later. That evening I started bleeding and filled the toilet 4-5 times and could not stop the bleeding. My wife called 911 and was rushed to hospital. They finally controlled the bleeding. I had lost 2 pints of blood. My hemoglobin count went from 12 to 6.

  3. Larry
    Chapel Hill
    Reply

    Any parallels between Xeralto’s side effects and Eliquis???

  4. william w.
    Crystal Springs, Ms.
    Reply

    Have been on Xarelto since August /11/2015. On, August/17/2015, while enjoying the afternoon with my 3-year old grandson, I was in the kitchen preparing a cup of chocolate milk for my grandson when suddenly a excruciating pain started in my abdomen radiating to my shoulders, neck, and arms. Right arm and hand was tingling, and left arm had more pain and hand felt numb. Within a few seconds I became weak. I knew that I had to sit down and headed for our couch, 3 to 4 steps away. I carry Nitrostat, but they were on the kitchen table,a nd was too weak to reach them. I remember reaching the couch and asking God to please not let me die in the presence of my Grandson. I regained consciousness, couldn’t have been out over a couple of minutes. Dr. in E.R. said incident probably not related to Xarelto.

  5. Sheila
    Ct.
    Reply

    My sister-in-law took xarelto to prevent blood clots for nearly 2 years. Recently, she began to have shortness of breath and it finally caused her to be admitted to the hospital. She had to have surgery because it was thought that the pericardium was filled with fluid. Instead, the surgeon was shocked to discover that it was filled with blood. She’s much better, but still has drains in her chest. It was a very frightening experience for her and her family. However, the doctors are very reluctant to blame the drug. We know that it can cause internal bleeding and she has refused to go back on the drug, even though that has been suggested by a cardiologist. She will go back on coumadin but there is no way she’ll ever take xarelto again.

  6. Molly
    Oregon
    Reply

    I have been on Xarelto for almost two years now and have had no issues with taking it and no new clots. I have a history of unprovoked Pulmonary embolism- I have had 5 in the past ten years with multiple smaller clots in between- it all started after kidney surgery in 2004- because I have congenital issues with my Kidney system- most assume it is still coming from there but because I don’t have good insurance- no one will do the diagnostics necessary to find the root cause. Recently I had part one of a urology surgery- and no one can tell me what to do with the bleeding I am experiencing.

    The Urologist says bleeding with urination is normal after surgery for up to 5 weeks. I did not start bleeding until three days after surgery when I resumed Xarelto- the blood fills the toilet bowl. My Hematologist is useless- won’t even call me back- so I am on my own to figure this out. I need to heal from the first surgery well enough to have part two or I will have more urological issues than I already have- but if I don’t take enough Xarelto- I will clot again for sure. So here I am.

  7. Charlie
    Liverpool
    Reply

    Really concerned my partner has af and has been taking Rivaxaban for about 6 months no problems until today. He’s spitting up loads of blood he’s gone the hospital in another City as that’s where here works what can they do for him? any thoughts?

  8. Alex Probst
    Wilmington, NC
    Reply

    The replys were very helpful. My cardiologist wants me to take xarelto for AFIB.
    I have been taking aspirin for over 20 years. I have had a skipped beat for over 25 years.
    I have been doing research on this drug and to be truthful I don’t think I want to take this drug.

  9. Linda
    CA
    Reply

    My mom of 86 years was on this drug for almost 2 years. 12/14 bad stomach pain, weakness, almost passed out. Paramedics took her to emergency. The next day after all the tests were reviewed, the doctors stated that her spleen was fractured in a few places and she was bleeding from her spleen into her stomach. They kept asking me has she fallen and I told them no. She lived with me and I take care of her, and if she fell she would not be able to get up on her own.

    They operated and took the spleen out and cleaned out her stomach of 4-5 liters of blood. She was placed on support after the surgery. The next morning my mom died.

    The doctor told her that this medicine was much for her in a long run because it wasn’t so hard on her stomach. She had some health issues which were under control. This came on suddenly and she had so much pain. The doctors at the hospital were concerned because of the Xarelto. The drug stayed in her system and she bled out. I want to make sure that no one else has to go through this.

  10. Tina
    Florida
    Reply

    I have been prescribed Xarelto after I had surgery and developed PE, I have to take Xarelto for six months and Im nearing the time to stop taking it. I am getting a little nervous due to the research I am finding out. Has anyone had a PE and taken Xarelto and then came off of it? What happened, anything? Any info will help…

  11. cory
    indiana
    Reply

    My mother was prescribed xarelto was on it for two months then went to the hospital because of breathing complications. She was pretty healthy, but was complaining a lot about her legs being so weak. She went by ambulance. By the time I saw her again she was in a coma.

    They did a abdominal surgery on her and she bled 5 pints of blood. They had to take her back into surgery and cauterize her arteries. 4 days later she passed away from internal bleeding in her stomach and head. Could Xarelto have taken her life?

  12. FM
    Reply

    I was at the hematologist’s today and mentioned the People’s Pharmacy comment. She said yes, that was obviously a death related to the drug. So, I expressed my concerns once again. She said the biggest problem is being in an accident and becoming unconscious, so you can’t tell someone you’re on Xarelto (she suggested the medical ID tag) and then if you need emergency surgery for internal injuries, they’ll cut you open and you’ll start bleeding all over the place. In theory it should take 12 hours for that to stop. A stroke seems like another likely disaster in the making. There’s
    a new test that just came out which I got today but don’t yet know the results – it tells you, supposedly, exactly how coagulated you are on Xarelto. Hematologist says the fix is in Stage 2 trials, nowhere near ready. I’m starting to think I might revert to Coumadin, with all its many problems, at least until the fix is in. Though I’ve had no problems at all in the year I’ve been taking Xarelto.

  13. bob
    Reply

    Doc prescribed Xarelto because of newly diagnosed Afib. Within a month stools turned black.
    Had to stop. Stools returned to normal after a week. Had upper and lower endoscopies. Negative.
    Now gastro doc wants me to resume Xarelto and then have capsule endoscopy to find source of bleeding
    which as I noted has stopped. Thank you no. Heart doc never reported the bleeding problem as far as I know. Makes one wonder how many unreported problems there have been.

    • Diane
      Connecticut
      Reply

      Bob, I asked my doctor at last visit when the antidote for Xarelto-induced bleeding will be available and he said “this August”, hopefully.
      I just bumped into an old friend at Cardiac Rehab that I hadn’t seen in many years — we went to breakfast together and the subject of Xarelto came up.

      He described his experience as follows: internal bleeding was suspect, but no-one could determine where it was happening. His niece was a doctor out of John Hopkins who was supposed to be expert in cases like this — she consulted him, and with his help, the source was located. Surgery and 29 pints of blood later, he survived the ordeal. I have been on Xarelto for a year or so and appreciate the fact that I can still eat the vegetables I love, but not a day goes by when I’m not dealing with the fear of what the drug might be doing to me.

      • Michael
        Connecticut
        Reply

        I have an 87 year old Mom who was prescribed Xarelto for atrial fibrillation and has been taking it for a couple of years.
        She is currently in the hospital and losing blood with internal bleeding suspected. There is no abdominal pain and no visible blood detected in the stool. Endoscopy and colonoscopy results were inconclusive. The doctors are stumped. How does one locate the source as in Diane’s case? Help please!

        • Michael
          Connecticut
          Reply

          Correction. My Mom was on Pradaxa for a couple of years and just recently within the past two months was switched to Zarelto.

  14. FM
    Reply

    I’m concerned about the original question posed – obviously the death was not reported as a consequence of the medication, though that seems to
    be the case. Are there any available numbers about deaths from accidents, etc. where transfusions have been unable to halt the bleeding? I take Xarelto for Factor V genetic clotting factor – one year now – and am worried about it. I was not well controlled on coumadin, however. I love Xarelto in general, though it’s a crapshoot if you’re in an accident or need emergency surgery. A fix may be in the works, but a couple of years away…

  15. sdf
    Reply

    I take coumadin and have for about 10 years. My Dr retired and new doctor wanted to change me to one of the new blood thinning meds but after research and seeing that if you do bleed while taking the newer drugs there is no way to reverse the bleeding.
    With Coumadin you can get a shot of Vitamin K and reverse the bleeding – so I declind – also as stated by others the new meds for blood thinning are lots more expensive than Coumadin. I love vegetables and worked w/my diet and coumadin intake to the point that I could eat 100 mg of Vitakin K Vege’s everyday by taking three 5mcg tabs and four 2.5 mcg of coumadin per week I could get in my daily vitamin K vege’s – If something came up where I could not or did not eat the vitamin K vege’s I took a 100mg of Vit K tablet that day.
    In other words my coumadin and diet were set up to allow me to eat 100 mg of Vit K per day and if I didn’t I took a 100mg vitamin K tab. This worked perfect for me – Was able to keep my Pro Time from 2 to 3 all the time. If you miss your green vege’s work w/your Dr to allow for them.

  16. KH
    Reply

    Thank you for the above. The more I learn (through my own research – not what Doctors seldom tell me) about the dangerous side effects and drug interaction, the more unlikely I am to take certain prescribed medicines. This puts me and other skeptics in the category “Non-Compliant”. Then the relationship with one’s doctors becomes strained. Are there readings as to how to navigate these difficult doctor-patient disagreements without mutual estrangement?

  17. SWG
    Reply

    I, too, am thoroughly confused as to why these new anti-coagulants are being prescribed so freely by cardiologists. I have had 2 cardiologists and 1 electro-physiologist recently suggest I to switch from Coumadin to Xarelto. A neurosurgeon I also saw said, “NO WAY!” He has seen patients bleed to death before they could be treated for stroke or aneurisym.
    The doctors in favor of the new drug brush off my requests of what to do about bleeding problems and can’t seem to give me a straight answer. And, all 3 cardios said Xarelto is the drug THEY would take. I don’t get it! And, by the way, Xarelto is considerably more expensive than warfarin or Coumadin. If a person is managing well under this drug, I don’t know why we should change. (I am having no problem with my current Coumadin!)

  18. KH
    Reply

    For nearly two years my cardiologist prescribed a combination of Lopressor and low-dose aspirin for my A-Fib.
    After he retired, my new cardiologist wanted to give me Xarelto although nothing had changed in my condition and although I rated ZERO on the risk factor scale for likelihood of stroke.
    Before taking the Xarelto I checked it on this website and Wikipedia and decided to get a second opinion. My wife, a medical researcher, pointed out that Xarelto still hasn’t been on the market long enough for any long-term studies to have been made regarding its effectiveness and safety.
    That my choices should be limited to dying from stroke or irreversible internal hemorrhage seems to me barbaric. Is this the best 21st Century doctors can offer – and without a word of warning?
    PEOPLE’S PHARMACY RESPONSE:
    There is a fascinating series of articles in the journal BMJ about another “new” anticoagulant prescribed for atrial fibrillation (A-fib). The drug is Pradaxa (dabigatran). This amazing story of woe and intrigue is embargoed until noon Wednesday. We suggest checking the BMJ on Wednesday, July 23, 2014 to learn about another anticoagulant.

  19. fbl
    Reply

    I took Xarelto for a little over a month back in Dec. of 2011. It caused excruciating stabbing pain in my large muscles and they wasted to almost nothing. My family Dr. did acupuncture and my muscles did come back but they are weak and I still have muscle aches and pains..also a bubbling feeling in the calves and thighs. The severe stabbing pain stopped after I stopped the med.
    What did that drug do to my body that I would still have such severe problems with my muscles 2 1/2 years later? None of my physicians have a clue. The circulation was checked and it is really good (I exercise regularly-yes even with the pain).

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