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Is Xarelto advisable before knee surgery?

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Posted on Fri, 6 Jan 2017
Question: Hi, thank you! I was recently prescribed 20 mg of Xarelto once a day for atrial fibrillation. Two weeks ago i went to ER for chest pressure, shortness of breath and irregular heartbeat, after waiting overnight , sleeping, to see if it would resolve itself(I'm a carpenter, right? And have had slight "palpitations before). Two ekg's, X-rays, blood work and an echocardiogram confirm that i'm pretty healthy, yay, I don't smoke or drink, don't get enough cardio exercise, could eat better, though I,m physically fairly active. Work had been a stressfull, anxiety producing b%#ch for some time, it's dark, it,s raining and cold, i can't do my motorcycle meditation, I'm 65, my knee's giving me problems, I've been drinking tons of coffee, and then I was unexpectedly laid off. WELL- The a-fib seems to have resolved itself, I've been still active but taking it easy(I live in the woods, it's snowing, there's firewood, plowing, shoveling), and resolving to take the opportunity to wake up again now that I'm settling down a bit. My doctor wants me to take the Xarelto for 3 months, log instances of a-fib and pulse, then if all seems well possibly wear a moniter for a day or two, before discontinuing the Xarelto. I just visited the orthopedist? who operated on my knee 12 years ago- torn meniscus, microfracture- He's cleared me for skiing with a brace, would have prescribed an anti-inflammatory but for the Xarelto, gave me a few years before at least a partial knee replacement(great guy, I've had hernia surgery too,modern medicine is amazing!). Opinion please? Am i safe with my occupation, not to mention skiing, on this drug? I'm careful, life is risky, accidents happen. I've read what's readily available about it, was a little alarmed about the idea that going off it increases the risk of stroke, would like to have the anti-inflammatory available to me, am feeling like possibly the sooner i get off it the better, and i seriously hate the thought of getting involved in the whole 'old people, their ailments and medications' paradigm. I also wish to be prudent and listen to those who are- thankfully- more informed than myself. Thank you for this wonderful opportunity, sorry to be so wordy! XXXX, Hope, XXXX.
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Answered by Dr. Sameer Maheshwari (7 hours later)
Brief Answer:
Don't worry & take medicine regularly.

Detailed Answer:
Hi,
This is Dr Sameer here, cardiologist from fortis hospital.
First about your AF. AF has certain causes. If your echo & relevant blood tests are fine, that means you are having a Lone AF, that means the AF is without any associated heart disease. AF causes irregular heart rate & high chances of clot formation in heart. This clot can travel to any part of the body through the blood vessels & can cause condition like stroke because of clot going to brain.
You have been prescribed a newer anticoagulant in the form of Xarelto which helps in preventing the clot formation by keeping the blood thin. So it is very important for you to keep continuing this medication. The time for continuing this medication depends on the duration of AF. If the AF is persistent than this medication will continue life long. Wearing a holter, which is monitoring of your heart beat for 24 continuous hours helps to rule out that. So do that test.

Coming to your knee surgery. For any patient on Xarelto, doing any elective surgery needs discontinuation of Xarelto for at least 5 days. In that period you are kept on injectable blood thinner which are given subcutaneously. So keep that in mind too.

So i wish you a very good health. Avoid excess coffee intake as it can increase heart rate. Be active, avoid smoking and alcohol.
Rest don't worry you will be fine.
Thanks a lot
Dr Sameer Maheshwari
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Follow up: Dr. Sameer Maheshwari (32 hours later)
Thank you Dr.Maheshwari, for your expertise and reassurance- XXXX
doctor
Answered by Dr. Sameer Maheshwari (1 hour later)
Brief Answer:
My pleasure, always will be there to help

Detailed Answer:
Hi,
Thank you Mr XXXX for your kind words. Will always be there to help.
Be happy, be health & keep smiling to live life to the fullest as the saying says " Start everyday with a new hope, leave bad memories behind & have faith for a better tomorrow"

Thanks
Dr Sameer Maheshwari
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Sameer Maheshwari

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Practicing since :2010

Answered : 814 Questions

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Is Xarelto advisable before knee surgery?

Brief Answer: Don't worry & take medicine regularly. Detailed Answer: Hi, This is Dr Sameer here, cardiologist from fortis hospital. First about your AF. AF has certain causes. If your echo & relevant blood tests are fine, that means you are having a Lone AF, that means the AF is without any associated heart disease. AF causes irregular heart rate & high chances of clot formation in heart. This clot can travel to any part of the body through the blood vessels & can cause condition like stroke because of clot going to brain. You have been prescribed a newer anticoagulant in the form of Xarelto which helps in preventing the clot formation by keeping the blood thin. So it is very important for you to keep continuing this medication. The time for continuing this medication depends on the duration of AF. If the AF is persistent than this medication will continue life long. Wearing a holter, which is monitoring of your heart beat for 24 continuous hours helps to rule out that. So do that test. Coming to your knee surgery. For any patient on Xarelto, doing any elective surgery needs discontinuation of Xarelto for at least 5 days. In that period you are kept on injectable blood thinner which are given subcutaneously. So keep that in mind too. So i wish you a very good health. Avoid excess coffee intake as it can increase heart rate. Be active, avoid smoking and alcohol. Rest don't worry you will be fine. Thanks a lot Dr Sameer Maheshwari