Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and htank you for asking on HCM!

I would explain that splinter hemorrhages occur when tiny blood clots block the flow of blood in the capillaries beneath the fingernails and toenails.

The most common cause of splinter hemorrhages is simple trauma or minor injury to a finger or toe, which results in minute amount of bleeding underneath the nail plate.

There are other occasions, however, in which the splinter hemorrhage may be a sign of some abnormality:
- fungus infection of the nail
- drugs like aspirin or xarelto intake.
- Raynauds disease can also cause them
- heart valve disorders,
- diabetes,
- connective tissue disorders etc..

So, to conclude it is necessary to differentiate the possible cause that may have lead to this symptomatology in your case:

a) Xarelto intake: Xarelto is known to cause bleeding in different parts of the body as an adverse effect.
b) Raynauds disease.

I would like to know how long have you been suffering from Raynauds disease?
Did you have these problems before (when you didn't take xarelto)?
Are these symptoms exacerbated by xarelto intake?

I would recommend performing some tests to evaluate your clinical situation:

- complete blood count including platelet count
- coagulation tests
- inflammation tests (PCR, sedimentation rate).

If your symptoms have been exacerbated since you started taking xarelto, you should discuss with your doctor on the possibility of switching to another therapy for DVT (like low molecular weight heparin or warfarin).

If you have had these symptoms before, when suffering from Raynaud syndrome but not taking xarelto, further tests would be needed to investigate for any other possible cause (like connective tissue disorders) which could also cause this symptomatology (Raynaud syndrome, splinter hemorrhages and DVT in right axillary) . In such case you should consult with a specialist of this field in order to find the proper treatment options to the underlying pathology.

Hope to have been helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri

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Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

You should know that it is not normal for a 22 years old female (or 35 years old like you are now) to have DVT.

From the other hand the changes that you refer in your fingers are not typical changes related to Raynauds syndrome (the fingers usually turn blue or pink in this disorder, when there is a cold environment).

I would recommend consulting with a rheumatologist or your attending physician in order to perform further tests to investigate for the possible causes (a connective tissue disorders, inflammation or a vascular disorder) underlying your symptomatology.

If such disorder is diagnosed, you should treat the underlying cause, besides anticoagulation for DVT.

I would be happy to review your uploaded angio CT scan for another professional opinion.

Regarding Xarelto, as it seems to have exacerbated your symptoms, I would recommend discussing with the prescribing doctor the possibility of switching to another anticoagulation agent (warfarin or lovenox injections), to avoid these adverse effects.

Hope to have been helpful!

Wishing a nice weekend,

Dr. Iliri

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