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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes venous thrombosis?

Answered by
Dr.
Dr. Hardik Sanghvi

Hematologist

Practicing since :2008

Answered : 7039 Questions

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Posted on Mon, 20 Apr 2015 in Hypertension and Heart Disease
Question: I am 46 and never had health problems until 2 weeks ago I had 3 aterial embolisms. One occluded/infarcted part of my spleen, the other occluded/infarcted (but passed) part of my kidney. The third was in the mesenteric artery. Had emergency stent and gratefully no intestinal ischemia. Docs are putting me on Xarelto. No antiphospholipid syndrome, negative ANA (no autoimmune). They are skeptical of genetic protein C&S factors that run in 3 generations of my family because that is usually associated with venal thrombosis. My whole family does great on Coumadin. I am very concerned about Xarelto because of lack of antidote and current press w/lawsuits due to hemorrhaging. Should I insist on Coumadin? Why do hematologists and vasculars like Xarelto?
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Answered by Dr. Hardik Sanghvi 58 minutes later
Brief Answer:
You can take xarelto or coumadin.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.
You have high risk of thrombosis which can leads to stroke or other pulmonary embolism or other artery occlusion.
You need blood thinner to prevent clot formation.

Choice of anti coagulant is very tricky.
You can take older drug like coumadin (warferin). Or you can take newer drug like xarelto (rivaroxabin) and others.

Mechanism of action are almost similar. They act on coagulation cascade.

There are few advantages of newer drug xarelto over coumadin.

xarelto is more effective in preventing stroke. Its dosage and blood level variations are less complicated than coumadin. No food can alter the blood level. Dosage schedule is easy. Single or twice daily dose is enough. No frequently monitoring is required.

coumadin need frequently monitoring. Various drug interactions and food affect the level. If the level of coumadin increase then bleeding chance is high and if blood level decrease then chances of clotting are high. Vitamin K rich food lessen the effectiveness of drugs. These factors favours use of xarelto over coumadin.

However if patient is doing well on coumadin then there is no need of newer and costly drug like xarelto.

Major disadvantage of xarelto is lac of antidote. So if blood level is increased then there is risk of bleeding. Allergy and spinal problem with xarelto are also there.

You should consult your doctor and discuss about this. If you are comfortable with coumadin dosage schedule and monitoring then there is no need of xarelto.

Consult your doctor and take treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by : Dr. Yogesh D
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