Finding resilience after recurring events

JOE

Age 68

Diagnosed with DVT/PE in 2012

Joe is a 68-year-old retiree who lives in Hawaii. He spends his time going to the beach, fishing, cycling, and gardening with his wife. By the looks of it, you would never know that Joe has suffered from recurring pulmonary embolisms (PE). His first one occurred in the middle of the night after a flight from Hawaii to Arizona. "I woke up and couldn't take a full breath, so I went to the emergency room," Joe said. There, the doctor asked Joe if he was having trouble with his left leg and if he had recently been on an airplane for an extended period. The answer to both was yes, and after "a battery of tests," Joe's doctors determined he had a PE. "I was surprised and very overwhelmed," Joe said. "There had been a knot in my left leg. I did the normal thing. Massage the muscle. Soak it in hot water. I did all those kind of things…and nothing seemed to work. [Had] I known about pulmonary embolisms, I probably would've got up and walked around, drank more water, all the things that I do now [while traveling]." Joe was prescribed warfarin to treat and help reduce the risk of another PE.

lineWhat is DVT/PE?

A PE occurs when a blood clot called a deep vein thrombosis (DVT) forms and travels to your lungs. DVT forms in a vein deep inside your body, such as in the legs. DVT is the third most common vascular diagnosis behind heart attack and stroke. It affects between 300,000 and 600,000 people in the US every year.

An estimated 60,000-100,000 Americans DIE OF DVT/PE every year.

Up to 12% of future DVT or PE blood clots RESULT IN A FATAL PE.

lineRisk Factors

Certain people are at higher risk for DVT/PE events: those who smoke, are over the age of 60, overweight, pregnant, or have a family history of blood clots. Slow blood flow due to immobility during extended travel, having a recent injury or surgery, and taking hormone medications are also risk factors. Joe met several of these criteria and experienced some telltale symptoms, which helped his doctors diagnose him. "Unexplained acute cough, especially if associated with blood, new and sudden shortness of breath, low oxygen levels, and, in extreme situations, cramping of the calf muscle, chest pain, passing out, or vision changes" are signs to watch out for, according to Dr. Kamran Boka, a pulmonary attending physician.

FAMILIARIZE YOURSELF WITH THE RISK FACTORS

slow blood

SLOW BLOOD FLOW

  • During extended travel
  • After surgery
  • During illness
1

CERTAIN MEDICATIONS

  • Oral contraceptives
  • Hormone therapy
  • Cancer treatments
1

CERTAIN CHARACTERISTICS

  • Being overweight
  • Smoking
  • Being over 60 years of age
1

INJURY TO A DEEP VEIN

  • Surgery
  • Trauma
1

MEDICAL HISTORY

  • Blood clotting disorders
  • Family history of blood clots
1

If you've already had a DVT or PE, YOUR RISK FOR ANOTHER INCREASES OVER TIME.

Joe's
Turning Point

Unfortunately, Joe's first PE was not his last. "The disheartening thing is once you have one, you're more susceptible to have another one," Joe said. A year later, he was setting up chairs for an event when he started feeling the same sensation in his chest that he felt the night of his first PE. Immediately, Joe knew what was happening and went to the hospital, where he was diagnosed with another PE. There were no obvious causes for this event, so Joe continued taking warfarin, the medication initially prescribed for his condition, until he had yet another PE blood clot event the next year. That's when he and his doctors decided to revisit his treatment plan.

There are different types of blood thinners that treat DVT/PE. Anticoagulants help prevent or reduce blood clotting, and antiplatelet drugs help keep platelets (a type of blood cell) from sticking together and forming a clot.

We want to reduce the stickiness of the blood and prevent existing clots from getting bigger. Anticoagulation blocks clotting and reduces that from happening."

Dr. Kamran Boka

Joe's doctors recommended he start taking XARELTO, a blood thinner prescribed to treat and reduce the risk of DVT/PE blood clots from happening again. "I was happy to get it and happy to get on with my life," Joe said. "Getting back [to your life] after you've had a PE is the place every patient wants to be."

How do I know if I'm at risk for a DVT or PE event?

Deep vein thrombosis (DVT) and pulmonary embolism (PE) blood clot events can be unexpected and scary, and there are several risk factors known to increase the possibility of a DVT/PE event.

What are the symptoms of DVT?

A common symptom is swelling in the affected limb, which is usually in the leg.

You might also feel cramping that turns into pain, skin that is warm to the touch, or see red or discolored skin.

What are the symptoms of PE?

Symptoms include sudden or unexplained shortness of breath, rapid breathing, chest pain under the rib cage that may worsen with deep breaths, feeling lightheaded, or coughing up blood.

What are the consequences?

PE is actually a complication of DVT and occurs when the DVT blood clot travels to the lungs. This blocks blood flow to the lungs, which can be life-threatening.

What do I do if I have a DVT or PE event?

If you experience any symptoms of DVT or PE, seek medical attention immediately. This is because a DVT can become a PE, and PEs are often confused with other conditions like pneumonia.

It can be difficult for you to determine how serious the situation is. Blood clots can be life-threatening, so it's important to notify your doctor right away.

How can I help prevent a DVT or PE event?

There are simple things you can do to reduce the risk of DVT/PE: avoiding sitting still for long periods, maintaining a healthy weight, staying active, and quitting smoking.

However, if you've already had an event, your risk of having another increases over time. In this case, taking blood thinners may help in prevention.

What treatments are available for DVT/PE?

Blood thinners are used to treat DVT/PE blood clots by helping to prevent blood clots from growing larger and helping stop other clots from forming.

XARELTO is a blood thinner proven to treat and reduce the risk of DVT/PE blood clots from happening again. In clinical studies, almost 98% of people taking XARELTO did not experience another DVT or PE.*

XARELTO has no known dietary restrictions and doesn't require regular blood monitoring.

*patients were followed for an average of 208 days.

I completed treatment for my initial DVT/PE, am I still at risk?

After completing treatment for an initial DVT or PE, some people remain at risk for another event and may need to continue taking a blood thinner to help reduce their underlying risk. Some may take aspirin to help reduce their risk.

Is aspirin enough to help reduce my risk over time?

Aspirin may not be enough. XARELTO is the only blood thinner that has been studied against aspirin and was proven to significantly reduce the risk of recurrent DVT/PE in people who have completed six months of treatment for an initial event.

In a clinical trial, people taking XARELTO 10 mg were 3 times less likely to have another DVT or PE compared to people taking aspirin alone.

What else can I do to help reduce my risk of a future DVT/PE blood clot?

Be sure to do your research, maintain healthy habits, know the symptoms, keep in touch with your healthcare team and be sure to take your medication as prescribed.

Blood thinners are used to treat DVT/PE by PREVENTING CLOTS FROM GROWING AND NEW ONES FROM FORMING.

Blood thinners may continue to be taken to reduce the risk of future blood clots, even after completion of initial treatment. Work with your doctor to determine your need based on your risk factors.

AFTER 5 YEARS

5 percent

AFTER 10 YEARS

10 percent

After switching to XARELTO from warfarin, Joe noticed some immediate advantages. "[Warfarin] was problematic [for me] because of the [dietary] restrictions … And that was something you really had to watch out for," Joe said. "[You also] had to have your blood [tested regularly]. That's something you don't have to do with XARELTO."

People taking XARELTO will take a higher dose during the first three weeks after a DVT or PE blood clot diagnosis, when the risk of having another one is the highest.

If you've had a DVT or PE, your risk of having another one increases over time, particularly once you complete treatment and no longer take a prescription blood thinner. In addition, future events can be more serious—even life-threatening. Up to 12% of future DVT or PE blood clots result in a fatal PE. XARELTO was the only blood thinner studied vs aspirin that was proven to significantly reduce the risk of recurrent DVT/PE in people who had already completed six months of treatment for an initial event. In a clinical trial, people taking XARELTO 10 mg were 3 times less likely to have another DVT or PE compared to people taking aspirin alone.

lineMaintaining a Positive Outlook

Beyond taking his medication, Joe takes steps to stay healthy by eating right and keeping his weight down. "I work out a lot. I cycle. I do as much hiking and walking as I can," Joe said. He also leans on his wife for additional support. "My wife has been very supportive. We support each other in our health. She's more athletic than me, so that keeps me pretty active—trying to keep up with her." And he is committed to doing what he needs to do to stay healthy. "I just take [my medicine], do what my doctors say, try to stay as healthy as I can and live my life and be happy."

If you have had a DVT or PE event, you know how scary it can be; however, it is manageable with treatment. That's why it's important to listen to your body like Joe did and know any symptoms that might indicate a blood clot. Remember, DVT/PE events are often unexpected, and your risk of having another increases over time. Talk to your doctor about treatment options and how to best help lower your risk.

In clinical trials, almost 98% of people taking XARELTO DID NOT HAVE ANOTHER DVT OR PE.*

*Patients were followed for an average length of treatment of 208 days.

YOUR DOCTOR IS ALWAYS YOUR BEST RESOURCE. He or she knows your situation best and can help you determine a treatment plan.

Find out more about how to help reduce your risk of another DVT or PE with XARELTO

Learn More
WHAT IS XARELTO (rivaroxaban)?

XARELTO is a prescription medicine used to:

  • treat blood clots in the veins of your legs (deep vein thrombosis or DVT) or lungs (pulmonary embolism or PE)
  • reduce the risk of blood clots from happening again in adults who continue to be at risk for DVT or PE after receiving treatment for blood clots for at least 6 months
IMPORTANT SAFETY INFORMATION

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT XARELTO?

XARELTO may cause serious side effects, including:

  • Increased risk of blood clots if you stop taking XARELTO. People with atrial fibrillation (an irregular heart beat) that is not caused by a heart valve problem (nonvalvular) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. XARELTO lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO, you may have increased risk of forming a clot in your blood.
  • Do not stop taking XARELTO without talking to the doctor who prescribes it for you. Stopping XARELTO increases your risk of having a stroke. If you have to stop taking XARELTO, your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming.

  • Increased risk of bleeding. XARELTO can cause bleeding which can be serious and may lead to death. This is because XARELTO is a blood thinner medicine (anticoagulant) that lowers blood clotting. During treatment with XARELTO you are likely to bruise more easily, and it may take longer for bleeding to stop. You may be at higher risk of bleeding if you take XARELTO and have certain other medical problems.

You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding, including:

  • Aspirin or aspirin-containing products
  • Long-term (chronic) use of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Warfarin sodium (Coumadin, Jantoven)
  • Any medicine that contains heparin
  • Clopidogrel (Plavix)
  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
  • Other medicines to prevent or treat blood clots

Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above.

Call your doctor or get medical help right away if you or your child develop any of these signs or symptoms of bleeding:

  • Unexpected bleeding or bleeding that lasts a long time, such as:
  • Nosebleeds that happen often
  • Unusual bleeding from gums
  • Menstrual bleeding that is heavier than normal, or vaginal bleeding
  • Bleeding that is severe or you cannot control
  • Red, pink, or brown urine
  • Bright red or black stools (looks like tar)
  • Cough up blood or blood clots
  • Vomit blood or your vomit looks like "coffee grounds"
  • Headaches, feeling dizzy or weak
  • Pain, swelling, or new drainage at wound sites
  • Spinal or epidural blood clots (hematoma).People who take a blood thinner medicine (anticoagulant) like XARELTO, and have medicine injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). Your risk of developing a spinal or epidural blood clot is higher if:
    • A thin tube called an epidural catheter is placed in your back to give you certain medicine
    • You take NSAIDs or a medicine to prevent blood from clotting
    • You have a history of difficult or repeated epidural or spinal punctures
    • You have a history of problems with your spine or have had surgery on your spine
  • If you take XARELTO and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots.

    Tell your doctor right away if you have:

    • back pain
    • tingling
    • numbness
    • muscle weakness (especially in your legs and feet)
    • or loss of control of the bowels or bladder (incontinence)

    XARELTO is not for use in people with artificial heart valves.

    XARELTO is not for use in people with antiphospholipid syndrome (APS), especially with positive triple antibody testing.

    Do not take XARELTO if you or your child:

    • Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO if you currently have unusual bleeding.
    • Are allergic to rivaroxaban or any of the ingredients of XARELTO.

    Before taking XARELTO, tell your doctor about all your medical conditions, including if you or your child:

    • Have ever had bleeding problems
    • Have liver or kidney problems
    • Have antiphospholipid syndrome (APS)
    • Are pregnant or plan to become pregnant. It is not known if XARELTO will harm your unborn baby.
      • Tell your doctor right away if you become pregnant during treatment with XARELTO. Taking XARELTO while you are pregnant may increase the risk of bleeding in you or in your unborn baby.
      • Females who are able to become pregnant: Talk with your doctor about pregnancy planning during treatment with XARELTO. Talk with your doctor about your risk for severe uterine bleeding if you are treated with blood thinner medicines, including XARELTO.
      • If you take XARELTO during pregnancy, tell your doctor right away if you have any signs or symptoms of bleeding or blood loss.See "What is the most important information I should know about XARELTO?" for signs and symptoms of bleeding.
    • Are breastfeeding or plan to breastfeed. XARELTO may pass into your breast milk. Talk to your doctor about the best way to feed your baby during treatment with XARELTO.

    Tell all of your doctors and dentists that you or your child are taking XARELTO. They should talk to the doctor who prescribed XARELTO for you before you have any surgery, medical or dental procedure.

    Tell your doctor about all the medicines you or your child take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

    Some of your other medicines may affect the way XARELTO works, causing side effects. Certain medicines may increase your risk of bleeding. See "What is the most important information I should know about XARELTO?"

    HOW SHOULD I TAKE XARELTO?

    • Take XARELTO exactly as prescribed by your doctor.
    • Do not change your dose or stop taking XARELTO unless your doctor tells you to. Your doctor may change your dose if needed.
    • Your doctor will decide how long you should take XARELTO.
    • XARELTO may need to be stopped for one or more days before any surgery or medical or dental procedure. Your doctor will tell you when to stop taking XARELTO and when to start taking XARELTO again after your surgery or procedure.
    • If you need to stop taking XARELTO for any reason, talk to the doctor who prescribed XARELTO to you to find out when you should stop taking it. Do not stop taking XARELTO without first talking to the doctor who prescribes it to you.
    • If you have difficulty swallowing XARELTO tablets whole, talk to your doctor about other ways to take XARELTO.
    • Do not run out of XARELTO. Refill your prescription of XARELTO before you run out. When leaving the hospital following a hip or knee replacement, be sure that you will have XARELTO available to avoid missing any doses.
    • If you take too much XARELTO, go to the nearest hospital emergency room or call your doctor right away.

    If you take XARELTO for:

      • Atrial Fibrillation that is not caused by a heart valve problem:
        • Take XARELTO 1 time a day with your evening meal.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day.Take your next dose at your regularly scheduled time.
      • Blood clots in the veins of your legs or lungs:
        • Take XARELTO1 or 2 times a day as prescribed by your doctor.
        • For the 10-mg dose, XARELTO may be taken with or without food.
        • For the 15-mg and 20-mg doses, take XARELTO with food at the same time each day.
        • If you miss a dose:
          • If you take the 15-mg dose of XARELTO 2 times a day (a total of 30 mg of XARELTO in 1 day): Take XARELTO as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time.
          • If you take XARELTO 1 time a day: Take XARELTO as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Hip or knee replacement surgery:
        • Take XARELTO 1 time a day with or without food.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Blood clots in people hospitalized for an acute illness:
        • Take XARELTO 1 time a day, with or without food, while you are in the hospital and after you are discharged as prescribed by your doctor.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Reducing the risk of serious heart problems, heart attack and stroke in coronary artery disease:
        • Take XARELTO 2.5 mg 2 times a day with or without food.
        • If you miss a dose of XARELTO, take your next dose at your regularly scheduled time.
        • Take aspirin 75 to 100 mg once daily as instructed by your doctor.
      • Reducing the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems or stroke in people with peripheral artery disease, including those who have recently had a procedure to improve blood flow to the legs:
        • Take XARELTO 2.5 mg 2 times a day with or without food.
        • If you miss a dose of XARELTO, take your next dose at your regularly scheduled time.
        • Take aspirin 75 to 100 mg once daily as instructed by your doctor.

    For children who take XARELTO:

    • The dose of XARELTO depends on your child's body weight and will be calculated by your child's doctor. Your child's doctor will tell you if XARELTO can be given to your child with or without food.
    • The adult caregiver should give the dose.
    • If your child is taking the tablet, the tablet should be taken whole and should not be split in an attempt to provide a lower dose of XARELTO.
    • If your child is taking the oral suspension, use the syringes provided in the original carton. The suspension will be prepared by the pharmacy. See the Instructions for Use included in the carton on how to properly give a dose of XARELTO oral suspension to your child.
    • Do not switch between the XARELTO oral suspension or tablet without first talking to your doctor.
    • If your child vomits or spits up:
      • right after or within 30 minutes of taking the oral suspension, give a new full dose.
      • more than 30 minutes after taking the oral suspension, do not give the dose again. Give the next dose at the regularly scheduled time.
      • if vomiting or spitting up persists, contact your child's doctor right away.
    • If your child misses a dose:
      • If your child is taking XARELTO 1 time a day, give the dose as soon as you remember on the same day. If this is not possible, skip this dose and give the next dose at the regularly scheduled time.
      • If your child is taking XARELTO 2 times a day, give the missed morning dose as soon as you remember. You may give the missed morning dose together with the evening dose. However, a missed evening dose can only be taken in the same evening.
      • If your child is taking XARELTO 3 times a day, skip the missed dose and give the next dose at the regularly scheduled time.