Advanced age is associated with a dramatic increase in the rates of venous and arterial thrombotic events. Increases in fibrinogen, factors VIII and IX, and other coagulation proteins, without a proportional increase in anticoagulant factors, likely contribute to this risk.
Deep vein thrombosis and the development of pulmonary embolism are some of the main causes of morbidity and mortality in patients of all ages and medical backgrounds; nevertheless, elderly patients are at a higher risk of DVT than younger patients. Blood clots become more common as people get older, especially when they are over age 65.
As you age also, even though you may have taken a medication for decades, your body may react differently to it later in life. One reason for this is that your metabolism has slowed down. Some medicines need to be processed by your liver to benefit your health; slower digestion and liver function mean it may take longer for a drug to get into your bloodstream. Later, remnants of the medicine need to be eliminated from your body by the liver and kidneys. Slowdowns at this stage mean it may take longer for a drug to leave your body, so its effect lasts longer.
Studies also show that certain medications are less safe for older people, and it is important that you work with your provider or pharmacist to use medications that are safe for your age. The American Geriatrics Society’s Beers Criteria lists medications that may not be safe in older people and can be used as a tool when you talk with your provider or pharmacist about using safe medications.
What is Xarelto?
Xarelto is a brand of rivaroxaban, a prescription medication approved by the Food and Drug Administration (FDA) to prevent and treat certain blood clots. Depending on the condition it’s used for, Xarelto may be prescribed for either short-term or long-term use.
Xarelto is specifically approved for use in adults to:
• prevent blood clots and stroke related to atrial fibrillation that isn’t caused by a heart valve problem
• treat deep vein thrombosis (DVT) or pulmonary embolism (PE), which are types of blood clots
• reduce the risk of developing another DVT or PE
• prevent DVT and PE from developing after knee replacement or hip replacement surgery
• prevent blood clots that can cause heart attack, stroke, or death in people who have chronic (long-lasting) peripheral artery disease or chronic coronary artery disease
• prevent blood clots in certain people who are hospitalized with an acute (sudden or short-term) medical illness and are at risk for developing blood clots
Side Effects Of Xarelto In The Elderly
Novel anticoagulants, such as Xarelto (apixaban) are effective as warfarin in reducing the risk of stroke and are safer in elderly patients than warfarin. However, older people may have more Xarelto in their bodies over a longer period. This can cause side effects, particularly in the elderly population. Some of the side effects of Xarelto in the elderly include:
1. Bleeding: One of the most common side effects of Xarelto is bleeding, which can range from mild to severe. The elderly are at a higher risk for bleeding due to age-related changes in their blood vessels and increased use of other medications that can interfere with blood clotting.
2. Bruising: Xarelto can also cause easy bruising, which can be more pronounced in the elderly due to thinner and more fragile skin.
3. Gastrointestinal bleeding: Xarelto can cause bleeding in the stomach and intestines, which can be more serious in the elderly due to the higher risk of gastrointestinal complications.
4. Increased risk of falls: The use of Xarelto can increase the risk of falls in the elderly, which can lead to injuries such as fractures.
5. Kidney problems: Xarelto can affect kidney function, and the risk of kidney problems may be higher in the elderly due to age-related decline in kidney function.
6. Liver problems: Xarelto can also affect liver function, and the risk of liver problems may be higher in the elderly due to age-related changes in liver function.
7. Stroke: While Xarelto is used to prevent stroke in people with atrial fibrillation, there is a small risk of stroke in some patients, particularly in the elderly population.
It is important for elderly patients taking Xarelto to be closely monitored for these and other potential side effects. Patients should also inform their healthcare provider if they experience any symptoms such as unusual bleeding, severe bruising, or signs of kidney or liver problems.
Older people with atrial fibrillation (an irregular heartbeat) 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 an increased risk of forming a clot in your blood.
Warnings
Do not stop taking Xarelto without first talking to your doctor. Stopping suddenly can increase your risk of blood clots or stroke.
Xarelto can cause you to bleed more easily. Call your doctor at once if you have signs of bleeding such as: bleeding gums, nosebleeds, heavy menstrual periods or abnormal vaginal bleeding, blood in your urine, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds, headaches, or dizziness/fainting.
You should not use Xarelto if you have an artificial heart valve.
Many other drugs can increase your risk of bleeding when used with rivaroxaban. Tell your doctor about all medicines you have recently used.
Xarelto can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). Tell any doctor who treats you that you are taking rivaroxaban.
