Hematoma in the foot

Hematoma in the foot

I have been on dabagatran 150 MGM twice daily for 6 weeks for AF. Thursday evening I had a bleed on my left foot causing large hematoma which slowly resolved after ice and elevation leaving me with large bruise and smaller hematoma. Sunday about the same time I experienced the exact same thing in the same foot with the same resulting resolution...that is ice elevation and now a bruise on the bottom of my foot. No help from pharmacist or doctor who insisted I must have injured my foot which I did not do even once let alone twice! Doctor actually told me that some people injure themselves in their sleep and don't even know it! I really dislike taking this drug and am about ready to take my chances on not getting a stroke. I was also in the ER a couple weeks ago with gross hematuria. I will appreciate any comments, advice, whatever. Thank you.

26 Replies

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  • Please. Please don't risk having a stroke a small bleed is nothing in comparison you could be left paralysed unable to speak or worse since my friend had a stroke I have made it my mission tor event stroke wherever I can xx

  • Just wondering if you had any investigations after episode of haematuria? As you know there are other anticoagulants which may, due to the fact we all have our idiosyncrasies, suit you better. Am guessing you are not in UK. None here can nor should advise re medication. Have your physicians done A Hasbled score for your bleeding risk? I get spontaneous bruises on my fingers occasionally with warfarin but all spontaneous bleeds should be reported to your medical professional because,if they are truly spontaneous as you believe they could occur in places where they could cause issues.

  • Yes I am in the us. Have never heard of hasbled score. Thank you!

  • Please please be careful on dabigatron I was only on it for 2 weeks and suffered heavy bleeding from the back passage. Was immediately taken off the drug with a firm warning from my gp that as I cannot tolerate warfarin - the same applies to these newer drugs on the market!!!! I have been suffering with AF now for over 20 years and it now has been suggested that Ablation may help - I do hope so. Please do not tolerate this newer drug unless youy Gp thinks it is medically your only option. Good luck and keep us informed thru Health Unlocked

    From Gillyflower 13

  • If your doctor is not helpful, could you arrange to see another in the practice, or go to A&E. It is not recommended to stop this except under medical supervision, but nor is it recommended to continue with it with this reaction. There are other NOACs which might suit you better.

  • Kgkgkg13 How about this.??? get a genetic polymorphism test for the P450 cyp detox pathways (through the liver), by which most drugs leave the body. You can then see which pathways underfunction (a genetic tendency). Before taking a drug, check the pharmokinetics, which tell what pathways in the liver the drug uses to leave your body. You need a drug that does not use the underfunctioning pathways. --otherwise the drug does not leave your body as fast as it is supposed to and you get a toxic overload. Your doctor should be doing all this, but it seems we have to be proactive on our own behalves. Think of yourself as the CEO OF YOURSELF. Take charge. Get a subscription to uptodate.com and read about all the drugs for anticoagulation and the pros and cons of each. also look into the genetic detox pathway tests. Ont the above website there is an entire section discussing the different prescribing of anticoagulants for people with these polymorphisms that slow the detox of the drug form your body.

    Is the person prescribing this drug a specialist in such drugs. ?????Are you in the United States.???? I use warfarin (which I am not telling you to take since I am not your doctor) and seee a coumadin lab nurse once a month to check the INR .(the therapeutic range is 2.0--3.0 For my particular situation, my electro physiologist wants 2.0---2.5) When I started, the lab saw me once a week, then every 2 weeks and once stabilized, once a month.

    Due to my genetic polymorphism tests of the detox system, and the pathways warfarin detoxes through I had to start on a lower dose than usual (1.5) and worked up to a therapuetic dose of 2.8 Most people with my poolymorphisms of the P450 cyp detox system I need about 2.5 mg of warfarin a day or a tad more. Those without those genetic glitches usually start at 5 mg. and work up from there. A doctor who started me on 5 (ignoring the genetic tests I showed her), caused bleeding. These tests are given by genova diagnostics in ashland north carolina, and when I took them a doctor in california (geneticist) prescribed them and a plebotimist came to my house (New jersey) to take the blood draw, which was then mailed in a special package by UPS to Genova Diagnostics (at that time it was illegal for a doctor in New Jersey to prescribe the test--which does not mean it is a bad test-- but just that politics of the medical system sometimes makes it hard for people to get what they need) )

  • Thank you for your very helpful response. Yes I am in the US.

  • Not sure how that drug compares to apixiban (Eliquis), a NOAC, but I'm only on 2.5 mg twice a day and still get the occasional purple splotch on my arm, so 1) 150 mg sounds like a lot to me, and 2) we all have such different reactions because of personal chemistry. It seems appropriate to get a good evaluation of your bleed risk on this drug considering what else, unseen, could be so "tender". I was just at the emergency room (US) for diverticulitis and was given a concerned lecture by doc there about using NOAC when not in afib, wishing me to check with my heart doc, because of what he has seen in uncontrolled bleeding. This being my own concern all along, I assured him it had been discussed and probably why I am on the minimum dose. Your extreme bruising, twice, bears a good discussion, at least, about dosage and/or type of medication. Feet are pretty important and hard to not use regularly!

  • Thank you

  • teach2learn Every drug has a "normal" dose so 2,5 is the right dose for apixaban and ditto 150mg for dabigatran. There is no correlation in mg between different drugs.

  • I do actually realize that. But thanks for pointing it out.

  • teach2learn . Sorry,have friends who don't!! Be well.

  • Please don't risk a stroke. Would you risk a heart attack?

    A heart attack, if you survive it, is unlikely to leave you in a state of permanent disability, and in need of care. A stroke, however, is likely to result in a permanent disability, Possibly resulting in a permanent need for care, and hospitalisation. I'd not be that afraid of a stroke, if I could be sure it would kill me outright, but I can't. Unless you really feel like being cared for - fed, bathed, turned, etc. - 24hrs a day, 7 days a week, 52 weeks in every long, long year, don't risk a stroke! However, don't listen to the doctor - he sounds like a poor apology for a scientist! If a person denies having even slightly injured their foot, he should listen, not try to deny their first hand evidence! Go Back AGAIN, and if he refuses to listen, leave, and never darken his doors again. See another doctor, quickly, but don't risk a stroke. You hopefully have many years still to live!

  • I fully agree.

  • Thank you for that. I don't know why the doctor found it so unbelievable that's I didn't injure my foot. I don't think he wanted to believe it. I'm pretty sure it is likely to happen again though. The only anticoagulants insurance will cover is warfarin and dabigatron. Thanks for your comment. You believed me!

  • Might they cover one of the others if reactions are the problem. Worth asking.

  • I think those 2 are it, but I will make sure.

  • I'm in US also and it's true, insurance only covers these two. Eliquis is double the price. I'm on Pradaxa with occasional bruising but no others problems except a burning feeling in stomach at times. Pradaxa is known to crest stomach upset. Let us know how you do with Dr, good luck, Gracey

  • I have no stomach upset with it just a large amount of blood in the urine on one occasion and the two bleeds in my foot which were not caused by an injury. I have felt headaches too the last couple days but probably cause I am dealing with this s stuff.

  • So much to deal with its awful. I just keep asking questions and trying to get as much info as possible. I would see your Dr again and tell him that you won't be pushed aside but want an answer. If he doesn't answer you so that you are confident find another Dr. Where in Us are you? I'm in the Northeast with great Drs. Good luck, seems we all need it ! Gracey

  • I live in San Diego. When I talked to him yesterday he said to go to urgent care or family practice so what I told him could be documented. Wasn't it enough that I was telling him??! I am frustrated. I think the doctors are good enough but the managed care system is a problem. You get to see a cardiologist once a year!

  • There are, unfortunately, a lot of doctors who have a theory. When you see them, and you fit their theory, they are happy. When you don't, it is obviously YOU that is mistaken, not their theory. I have met quite a few of them, and refuse to let their theory get in my way of getting the proper treatment. If you know the truth, ensure that the doctor records it, even if they do not agree with it. Keep saying "You will record that I have said ....." until they give in, and if they refuse, send a polite note, confirming your side of things. This means that he HAS to take it into account, or be branded a bad doctor if something did go wrong.

    You know that you were uninjured, it doesn't fit in with his theory. He would rather believe that you were wrong than his own theory. I have no theory, so why should I not believe you?!

  • He even told me that some people injure themselves in their sleep and don't know it. That is how bad he wants to believe in his theory! Thank you for your comment.

  • I can't see this to that extent unless you have a constricted bed sides and bottom!!!

  • Very true!!!

  • I was diagnosed (in the US) with afib about 1 1/2 years ago and was initially prescribed Warfarin. I was on it for about 3 months, but didn't like the weekly blood draws. I asked my cardiologist for one of the newer anticoagulants. He prescribed Eliquis (apixaban) and I have been on it for over a year. At first, I noticed a a little bleeding under the skin (wrists and arms) from minor bumps. After several months, my metabolism seemed to have adjusted and the bleeding stopped. It is expensive, but my Medicare supplement insurance covered most of the cost until I recently reached the coverage limit. I am having to make do with doctor samples until I cross over the gap. I am 74, 155 lb., fit and in good health other than the afib. I keep active and routinely exercise. It appears that you do also and this is a good thing for affibers. Some of my friends with no heart or other major health issues have suffered unexpected strokes and now have different degrees of permanent loss of physical and mental functioning. At this point in my life, I would not consider discontinuing anticoagulant therapy and running the risk of having a stroke.

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