Hi,

One of our members here posted this thread on the DVT group and on the PE group, and included a link to a comparison chart of all the oral anticoagulants.

http://www.dailystrength.org/c/Deep_Vein_Thrombosis_DVT/forum/17950375-coumadin-and-new-anticoagulant-comparison

There's a reference to bleeding risks between warfarin and the newer anticoagulants. It appears that the risk for GI bleeds would be about the same, per the chart

Regardless if she's on warfarin or xarelto, her GI bleed history should be discussed with her prescribing doctor and her doc who is managing her post DVT if different from her prescribing doc. May not change the approach but at least it's noted should she develop a bleeding complication.

Hope she's doing ok. There's a PE board here too if you're interested.

Thanks, that link is useful. She's just left the hospital so doing much better!

It's hard sometimes when you first get home after a PE. The critical stage is over and done with, so you feel like, ok I'm back! But it can be a little bit of adjustment period once home from the hospital, because you feel tired and not quite yourself yet. Just putting that out there so you can be aware.

You should be ware that, unlike warfarin, there is no antidote for Xaralto / Rivaroxaban. This means that if she has a bleed they cannot stop the bleeding. With warfarin a shot of vit K reverses the drug. I am prone to bleeds and have been told quite categorically by my haematologist that Xaralto is a definite no no for me.

(I am homozygous for FVL and AT3 deficient and have had multiple PEs and DVTs even clotting on heparin - now on life time warfarin. I also have Ehlers Danlos and so propensity to bleeds)

While there is no "antidote" or reversal agent there is protocol for Xarelto if you do have a bleed that won't stop. Also my hematologist has told me that a vitamin K shot is not that fast -- it takes more than a few hours. If you have a brain bleed you are going to be in just as much trouble on Warfarin as Xarelto. There has been some evidence to show that people on Xarelto have less brain bleeds than people on Warfarin. Which would be important to someone in you Mother's age category. There is even some new thought that people on Warfarin that are over the age of 75 that are taking Warfarin for Atrial Fibulation need to come off of it and go on aspirin or reduce their INR because the risk of having a brain bleed may be greater than having a stroke.

I personally have known two people this past twelve months that have died due to brain bleeds while on Warfarin -- both on it for Afib. One was 99 so maybe not so surprising, but the other was only 62. I'm not writing this to scare anyone off Warfarin. Both Warfarin and Xarelto can have dangerous side effects that as users we all need to be aware of. We shouldn't dwell on them too much since we need anticoagulantion therapy and our doctors have deemed it safer for us to be on them than not, but we should be aware of them and wear a medic alert in case we get in an accident and can't speak.

I suspect your mother's doctor took in all the information on both drugs and prescribed the one that he felt would work best for your mother's situation.

Elderly people are more prone to bleeding on anticoagulants anyway so I don't think it's always a good indicator of how younger people would respond. Plus with warfarin you have to factor in those who may not be compliant with testing regularly and taking the correct dosage. Both my doc and my pharmacist said it would blow your mind how willy-nilly some people are when it comes to sticking to their warfarin regiment.

So I think there's a lot of things that you have to consider when researching this. I think it's a totally personal decision to be made between the patient and doctor. That chart I mentioned in my original response above is a good start because it gives you a snap shot of the differences between the newer anticoagulants and warfarin, including the lack of antidotes for bleeds with the newer anticoagulants and the risk for bleeding among all the anticoagulants.

And I agree, we shouldn't be scaring people about any of the anticoagulants but encouraging education on the matter.

Totally agree with rmb.

As far as bleeding on the new oral anticoagulants, research has found the risk to be equal to or less than Coumadin.

While there currently are no FDA approved reversal agents, there is a reversal agent (Andexanet) undergoing trials that works for Xarelto and Apixaban., but the drug is still early in its development., iIt has not yet been tested in patients. There is also a reversal agent that works for Dabigatran, also still relatively early in its development; it is about to be tested in patients.

One of the nicer things about the new oral anticoagulants is their half-life is relatively short so it is out of your system fairly fast (hours vice days as in the case of Coumadin).