I take Rivaroxaban and have done so for a couple of years without problem following a pulmonary embolism . My dose was increased to 20mg in December last year when I developed persistent AFib.
It is only in the last 2 weeks that I have started to have a problem with a bleeding gum, it’s always in the same place which is above a fixed dental bridge which spans 3 teeth and therefore not that easy to get to.
It doesn’t seem to bleed all the time but most certainly it does at times throughout the day and also at night as there is usually a spot or two of blood on the bed sheet.
I am due an appointment with my EP next week and will also arrange for a dental appointment as soon as possible.
In the meantime has anyone else had a problem with bleeding gums and did you find a solution.
I also have the same problem. The most important thing is not to get infection in you gums as this can affect afib. I wonder if it's worth using a salt water rince at night to keep this at bay ?
Without examining your mouth and checking your cleaning technique for the area, it is difficult to be sure. Dental bridges need to be cleaned carefully and can create inflammation that results in the gum bleeding, even in patients who are not taking anticoagulants.
Conversely, the majority of patients taking anticoagulants do not suffer with bleeding gums provided they maintain good oral hygiene.
I would suggest you book an appointment with a dentist or a dental hygienist as soon as possible so that they can examine the area and advise on its management. Book a private appointment if the wait for an NHS appointment is too long.
Meanwhile chlorhexidine gel - Corsodyl - applied to the area with your finger after cleaning your teeth - gently rub in all round the bridge. If it doesn’t bleed too much, and it is not painful, you can also apply it to the area where the missing tooth has been replaced by using an inter-proximal brush.
Phone a dental surgery to get an appointment as well - there could be some other periodontal issue in the area that needs to be addressed.
Thank you for your response, dental bridges are difficult to clean and best I think to make an appointment with my hygienist.
I’ve been going private for quite a few years now as it’s impossible to get an appointment with an nhs dentist or hygienist.
I’ve used Corsodyl before but never the gel which would be a lot easier to apply around a dental bridge with an inter proximal brush. Shopping on Monday I think.
However two comments, if the bleeding does relate to the AC it may be worth trying Apixaban/Edoxaban instead: incidentally my cardio changed my PIP AC from Rivaroxaban due to persuasive research (he didn't say anymore) from the States. Secondly, look at all options to stop the bleeding as infection is likely and is then on a highway to your heart, which I have read can contribute to starting an AF episode. Best wishes.
I have not had bleeding gums but did have frequent minor nose bleeds. Due to research cited above, I changed from Riveroxaban to Apixaban. Since then - about six months ago - I have had no nosebleeds. Might be worth a try?
I must say when I first started taking Rivaroxaban I suffered from a major nosebleed about once a month, which was a real pain. They stopped after about 6 months.
I will ask my EP at my next appointment, will be interesting what he says, I think however he will just tell me to see a dentist.
I went through this but it was solved by a trip to the hygienist and using the brushes in between my teeth. I take Apixaban but that wasn’t the culprit
The best of luck with them. My hygienist gave me a mixed pack of sizes. I use the larger one for a larger gap etc and and use the brush at an angle between my teeth. They bleed at first and then after a while of doing this it heals. I did mine twice a day. If I’m at home I try to do it after meals if I remember to dislodge any food.
I had the same issue with my gums on Rivaroxaban. Fortunately, at the time, I was only taking it as needed, so the issue resolved as soon as I stopped the thinner. At that point, I had my teeth cleaned and worked harder on my gums as the issue was not just Rivaroxban but the gum itself. Now, I'm back on thinners but my gums are in much better shape and no bleeding.
If this is the case with you, that you need to work harder on your gums, it's a bit of a catch 22 because the harder you work on your gums, the more potential for bleeding.
This is where a joint and shared medical decision comes in between you, your dentist and cardiologist. Do you go off Rivaroxaban for a while and get the gum issue resolved and then go back when the gums are stronger, or do you stay on Rivaroxaban and somehow try and work around it?
It's really another risk/reward decision because as you know gum health is very important and many studies also show it tied to cardiac health.
Lastly and especially if they want you to stay on thinners, you can always trying switching to another thinner like Eliquis which is dosed twice daily. Anecdotally, at least a couple of people, including myself, has found less bleeding after switching from Rivaroxaban to Eliquis. Could be a coincidence but could also be a more even delivery -- less peaks -- because of the twice a day dosing. Can't hurt to try. Alternatively, you can try brushing your teeth at a different time of the day and see if that helps the issue.
Meanwhile, try Gly-Oxide. Sometimes it works miracles for mouth and gum issues.
I think you are right in that it all boils down to me working harder on keeping my gums clean, a number of people have suggested using Corsodyl which I will try.
You mention Gly-Oxide which I have never heard of before and will google that to find who sells it.
I don’t want to stop anticoagulants even temporarily as it’s too risky but that’s interesting your comments on Eliquis and the 2 doses daily, that’s certainly something I will ask my EP about when I see him in a weeks time.
I think the Gly-Oxide was originally recommended by a dental hygienist. I found it on Amazon as well as the local pharmacy. Hopefully, you can get it in the UK.
Well DenBoy70, plenty of opinions to your question to feast on and try! I am also on Rivaroxaban 20mg daily and I also had problems with gum bleeding. My pillowcase was a mess some mornings!My OH suggested I may be too enthusiastic with my electric toothbrush, if that was the case I put it down to my dread of the dentist 😅
I asked my GP if I could take half a tablet daily but he was very much against that idea... He has seen too many stroke victims, too risky he said😕
I come to my query now and ask for your varied opinions my friends. I have permanent Afib, 81 years old and of slight build weighing 58.5kgs. Is there a case for someone like me to to just take 10mg of Rivaroxaban daily? I ignored my doctor's advice and proceeded to take just 10mg daily. My bleeding gums do not bleed anymore, I still brush my teeth with vigour but am I in danger of having a stroke I wonder, I know you can only voice an opinion but I'd love to hear your thoughts as I value every one, thank you for staying the course of my long essay 🙄🙄Tom
Just working through all the responses and suggestions the kind people on this forum have sent me and noticed your query on Rivaroxaban which I need to respond to.
I had been on 10mg of Rivaroxaban since 2019 as I had what’s called an unprovoked pulmonary embolism, in other words they didn’t know what caused the embolism. I was told that I would be on anticoagulants for life.
I developed AFib in December 2021 and which has always been persistent, I went to see my doctor and asked him specifically if 10mg was the correct strength of Rivaroxaban now that I had AFib and he said yes it was the correct dose.
I wasn’t happy with his answer as I had been doing a lot of reading on AFib and thought it should now be 20mg so I booked an appointment with a private cardiologist.
That was the best thing I have done because after doing an ecg and an echocardiogram he wrote to my doctor saying that with AFib I needed to be on full anticoagulantion and that my Rivaroxaban needed to be increased to 20mg, which the doctor actioned.
I had a cardioversion in February of this year which put me back into normal sinus rhythm, at a follow up consultation with my cardiologist I asked the question that now my heart was back in a normal rhythm could I reduce my Rivaroxaban back down to 10mg.
He said point blank no it must stay at 20mg as once you have had AFib, regardless of the type or duration you are now at a much higher risk of having a blood clot and a subsequent stroke and therefore it needs to remain as 20mg.
A few weeks later I went back into persistent AFib which is where I am now.
Your doctors advice was spot on, you are taking an unnecessary risk of a stroke by lowering your dose of Rivaroxaban. It doesn’t matter how much you may weigh it’s all about having the correct strength of anticoagulant in your system.
Don’t take the risk Tom it’s not worth it, take the 20mg and accept the minor discomforts of the medication against the chance of having what could be a life changing or even fatal stroke.
I have taken Rivaroxaban for over a year with no problem.
I went to an Hygienist for a regular treatment at my local dentist and was told that they have to be more careful with Rivaroxaban and that if I needed an extraction, I would be probably be advised to go to a local dental hospital as there is more chance of bleeding.
The consensus of replies suggests I need to work harder on keeping my gums in good condition and as you say you have to be more careful when taking anticoagulants.
The thought of needing an extraction at some point has crossed my mind before and the suggestion by your dentist to go to a dental hospital is a good idea.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
ECTOPICS, ACID REFLUX AND CHEWING GUM
Gum disease link to AFib and Ortner’s syndrome 
Bleeding (sorry …rather descriptive )
Bleeding on anticoagulants
