I have just been prescribed this drug by a consultant. I haven’t started it yet. Does anyone have anything, good or bad, to report about it? I am going to discuss whether I should take it with a GP later today- my regular GP advised against taking an anticoagulant at the moment. The consultant did not justify his choice of anticoagulant or explain any of the risks involved.
Xarelto (Riveroxaban): I have just been... - Atrial Fibrillati...
Xarelto (Riveroxaban)
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38 Replies
•
I should, of course, have written Rivaroxaban above not Riveroxaban.
BobDVolunteer
You have AF. That makes you five times more likely to have a stroke. Five times more likely than what I hear you ask? Well age, general heart health, blood pressure and any possible other health issues which are contained in the CHADS2VASC2 score system all come into play and with a score of 1 you need to carefully consider it. With a score of 2 there should be no argument and of course if you need any treatment such as cardioversion or ablation it is not optional. (You can work out your own CHADSVASC score if you go to the main AFA website . Also remember that scores can not be cancelled so for example controlled blood pressufre still counts and these days anything over 120/70 is thought to be high. )
People will talk about balancing against the HASBLED score which you can also work out BUT this is less a score but more an aide memoir of thing sto adress before anticoagulation and should not be used as an argumant NOT to take them .
Obviously you have a choice but do remember that AF related strokes account for about 20% of all strokes but that these represent 80% of the most serious and least recoverable ones due to the size of the embollii which are able to grow within the fibrillating heart.
Which anticoagulant you take is entirely up to you so long as you do not think aspirin which is not an anticoagulation will help you.
• in reply toBobD
Thanks. I’ve just been to see a GP who has strongly advised to take it. So I’ve decided I will. I will probably choose a time when I am on holiday and so can quickly get to the doctor if anything goes wrong. I might also look into whether Xarelto is the best choice. A nurse at BHF said adoxoban might be better but didn’t elaborate.
• in reply toBobD
One question: can you drink at all with rivaroxaban? I heard not. Is this possible with other anticoagulants?
In my view best not if you have AF full stop> I don't think anticoagulants make much difference although one would not wish to prescribe to an alcoholic for lots of reasons.
Considering blood pressure over 120/70 high for anyone in middle or old age after 2 readings of this is a strategy to get more people on blood pressure medication regardless of whether they have white coat syndrome or not. Thankfully my doctor does not fall for it. My blood pressure varies between 120/70 and 140/ 80 depending on how stressed I am about what I am consulting the doctor about. He recognises that and has never ever suggested I take medication. Blood pressure like most other health markers varies naturally for many reasons.
I love Rivaroxaban. I've taken it since May 2015.
There are a few downsides. It doesn't get on with grapefruit. You are supposed to take it in the middle of a meal, preferably one that includes something fatty. Double cream? Butter? Chips?
It takes you away from being simple for surgeons, dentists and paramedics to treat, but this is the same for all anticoagulants.
You are more likely to bleed to death in a serious accident. This can make you feel vulnerable but once you have cut yourself a few times, you become a bit more blasé about it. The silly use of the term blood thinner has much to answer for here.
To my mind, the advantage is a sense of protection. You are prudently doing what you can to prevent a stroke and personally I'd rather bleed to death than live totally incapacitated by a devastating stroke.
A lack of antidote worries me not at all.
CDreamer• in reply to
Bob - I was talking to a Geriatrician about anti-coagulants and he made an interesting comment about the elderly and anti-coagulant - talking about infirm elderly not just old geezers like us - and he was was saying that care homes don’t like having their patients on anti-coagulants because of the possibility of brain bleeds after falling.
It is interesting just how negative the perception is out there of anti-coagulation and how little we hear (apart from AA education) of just how important they are in reducing stroke risk.
Sorry Rellim - meant for Bob but hope useful for everyone.
I was at a presentation by Prof Gregory LIp* to medical professionals some years ago who commented that doctors were far more afraid of anticoagulatnts than patients. He said that if a doctor had a patient on anticoags who suffered a gastro intestinal bleed he was 50% or more less likely to prescribe a/c in the next six months but that having a patient with a stroke made no difference and did not make them more likely to prescribe them.
* leading UK specialist in anticoagulation and one of the authors of the CHADS2VASC2 system.
• in reply to
Apparently it wears off after 12 hours according to the GP. Dabigatran is the only one of the new anticoagulants which has a reversal agent.
Ensure you take it at the same time each day (within an hour so) and always eat with a substantial meal (500 calories) that contains protein and fat. Ensure your GP test your bloods for kidney & liver function regularly. The only problem I have known about was a friend of mine who did have some problems with liver functioning but when we drilled down into how and when she took she realised she was taking it at the same time each day - but not always eating her evening meal at the same time. Her follow up test showed function back to normal as she changed her protocol and ate when she took her meds.
If you type Rivoroxaban in search box you will see comments. Many people like this Med as you only need to take 1 pill a day.
If you have AF you would be well advised to be taking some sort of anticoagulant and Rivoroxaban is one of the now more established DOACs so quite a lot is known about it. Personally I would listen to the specialist over GP as they are often not as informed or up to date with latest thinking.
Best wishes.
Do you know which of the liver enzymes was affected on your friend’s liver function test CD? On my recent test my GGT was 194 (should be under 35) and the doctors said it’s likely associated with the Amiodarone which I have now stopped. I wonder if Rivaroxiban has any bearing on it as well.
• in reply toKaz747
I believe each of the DOACs apart from dabigatran is metabolised by the liver. I don’t think they commonly damage the liver but I did find a report of apixaban induced elevation of the liver enzymes [transaminases]. Presumamably if the liver is not functioning normally at the usual annual test,when then the dose might need to be reviewed.
• in reply toCDreamer
I trying to lose weight because of the AFib, so I am avoiding 500 calorie meals! I thought that losing weight was a way of, possibly, lightening the AF burden? I’m not vastly overweight but could benefit from losing a stone.
CDreamer• in reply to
And Rivoroxaban requires that you eat a main meal with fat in order for your body to metabolise the drug and be efficacious so may be talk to your GP about alternatives such as Apixaban which don’t require to be take with food?
I don’t count calories but am losing weight by cutting out carbs, increasing protein and fats and leafy veg - 500 calories is not a particularly large meal and should make no difference to any weight loss programme if it is your main mail.
Ha - great minds think alike guys - I think we all responded at the same time! 😉
You might find this thread useful
If you look up nhs.uk/conditions/anticoagu... you will find useful information and explanation. I read the uses of the different DOACs recently and there is a very slight difference between them. My cardiologist said I could choose but when I asked him to suggest one he went for Rivaroxaban, which I eventually decided didn't suit me because of the diet restrictions so I swapped to Apixaban. It might be worth knowing if there is specific reason why Rivaroxaban was the cardiologist's choice.
• in reply toBuffafly
What are the diet restrictions?
Buffafly• in reply to
As CDreamer said, to get the optimal effect, eat evening meal at regular times and should be a proper meal. I don't eat at regular times and when I have a flare up of bowel probs shouldn't eat solids at all for 24 hours. I have heard conflicting reports of what is necessary eg my GP said a couple of hours either way made no difference but I felt happier taking Apixaban which only requires a drink of water 😀 The best one is the one that suits you so that you always take it!
• in reply toBuffafly
You mean the Rivaroxaban causes bowel problems? And if you don’t eat a meal with it it is ineffective?
Buffafly• in reply to
No, already had them. Yes, less effective.
dd64• in reply to
my consultant told me to take to take rivaroxaban with food as it is taken into the system easier and is more efficient.
Luludean• in reply to
Yes, what diet restrictions? I have not been told of any, I just avoid cranberries and grapefruit but that is no big deal. I take Rivaraxaban same time each day , when I wake ,with a yoghurt . Never been given any specific guidelines. Been on it for 3 years no problems other than increasing joint pain , no one knows what that is due to.
• in reply toLuludean
I don't think you need to avoid cranberries.
Luludean• in reply to
Ok, one would have to eat a lorry load of the beastly things to upset the apple cart. May be it is just an old thing left over from being on Warfarine for years.. I think we all worry too much. January is nearly over!!
• in reply toLuludean
And in the Northern hemisphere, the evenings are getting longer!
I fought my previous gp for 2 years to get on anticoagulants. He even ignored a recommendation by the cholesterol clinic to put me on them.,despite a very strong family history of stroke. When I had a TIA,that was out of his hands. Iwas given apixaban straight away in hospital and referred to an EP. I will remain on this for life and totally agree! Af makes us vulnerable to devastating strokes,even after ablation,as AF could return at anytime,or become 'silent AF' anticoagulants protect us.
I have had no probems with it whatsoever.
I felt like I had flu all the time and I also had a feeling of brain fog .
Edoxaban suited me much better
• in reply to
They area all subtly different, but I don’t have the expertise to compare them. I would like to chose the best one.
CDreamer• in reply to
And the ‘best’ oneis the one that suits you and your lifestyle - and that will vary from person to person. There are advantages and disadvantages of all of them. I would say that Pradaxa (Dabigatran) has a high incidence of causing gastric problems which many of us have experienced but other than that there is not much difference, more preferences and whether or not they suit you personally. There is no universal ‘best’ one. You have been given a lot of excellent information and advice in this thread to digest and talk over with your GP but remember - doctors advice varies and they will often favour one brand over another from their own experience of their patient’s experience.
Thanks to everyone who replied on this thread.
Been on it for 13 Months now, no problems
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