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Xarelto Bleeding Risk Higher in Knee Surgery, Acute Illness


November 25, 2013 — The blood-thinning drug Xarelto (rivaroxaban) has been associated with a higher risk of bleeding in certain patients, according to Medscape. Researchers linked Xarelto to a nearly 3-fold increased risk of bleeding for acutely ill patients and a 4-fold increased risk of major bleeding in patients with Acute Coronary Syndrome (ACS).

Dr. Partha Sardar of New York Medical College presented the results of his research at the American Heart Association 2013 Scientific Sessions. The conclusions were based on data from 48 clinical trials involving five new blood-thinning drugs — Xarelto, Pradaxa, Eliquis, Lixiana, and darexaban. All of them have been introduced since 2010.

Researchers wanted to know how they performed compared to each other and also compared to warfarin and heparin, which have been mainstays of anticoagulant therapy for over 50 years.

Xarelto was also shown to reduce the risk of bleeding for patients at risk of pulmonary embolism (PE) or venous thromboembolism (VTE). However, Xarelto and other blood-thinners were significantly more likely to cause bleeding in patients with acute coronary syndrome (ACS), hip surgery, and acutely ill patients taking a blood-thinner as a prophylaxis against blood clots.

Higher risk of bleeding for new blood-thinners:

  • Hip surgery: 1.43-fold increased rate of major bleeding
  • Acute Coronary Syndrome (ACS): 3.27-fold increased rate of major bleeding
  • Medically ill thromboprophylaxis: 2.79-fold increased rate of major bleeding

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