Rebound effect of stopping xarelto

I recently posted about trying to get off of Xarelto because for the past 8 months, I have only had 2 episodes of afib, the last being 4 months ago. I went to my Dr. last week and he told me that by going off of the drug I could have a rebound effect immediately after going off of it, I have an increased chance of having a blood clot or stroke. He did say that I could switch over to aspirin but they do have a different mechanism for decreasing the likely hood of stroke. I have been too scared to go off of it now, because I do not want to have a stroke. I am looking for any experiences that people on this board have had when stopping xarelto, and have you heard anything about the rebound effect? I have called xarelto myself and my pharmacist and noone seems to have any clear answers. Am I going to have to stay on this drug because I have now been hijacked by it and the danger of discontinuing it is more dangerous than staying on it? I have had a lot of side effects from xarelto, which is the main reason I want off of it. Plus, there are no studies as to the long term effects of staying on it. I am only 61 and the likely hood of living 20 or 30 more years is a possibility.

I'm on Xeralto but intend to get off as soon as possible. I found an article: Discontinuation of Rivaroxaban

From the article:

"Temporary interruptions of the study drug were associated with event rates of roughly 5 to 6 per 100 patient-years and did not differ between rivaroxaban and warfarin patients."

I'm guessing this is a very low risk given the transistion time is only a few days? Hopefully someone else will add a better interpretation. Something else to worry about.

What really bothers me about that article is that it shows very clearly that they have no idea what the effects are from taking xarelto. In other words we who are on that drug are guinea pigs. I am so frustrated with this, if I hadn't been in a weakened state when I was prescribed it I would have researched it a lot more before I got on to it. Now I'm afraid to stay on it and afraid to get off of it.

Just taking drugs in general, it seems to me that if you tapered off of a drug over a long enough period of time, than you would'nt get a rebound effect.

I don’t think that xarelto works that way. It has a very short 1/2 life. Supposedly it is out of your system by the time you take your next dose. So even missing one dose is dangerous.

I don't think the information on short half life of these NOACs is correct. Going from a dim recollection, I thought Shannon commented in a post that one could go off it to have a dental procedure that involved surgery without severe consequences for clotting concerns.

I take Eliquis and have not read that there is a short half life...I could have missed it. One of the concerns is that taken regularly, it keeps the blood very thin and that's the risky part of these new drugs because there is no antidote and the risk of bleeding out is high if you're in an accident or having a brain bleed if you fall and hit your head.

Personally, I love the convenience of not having to go for INR testing and avoiding leafy greens, but I hate the idea that it is out there without a readily available antidote that is available in every ER or hospital across the nation. Apparently, there is one antidote available that used to cost $10,000 for each injection ... maybe that's changed by now but I haven't seen any "Hurrah" reports that it's readily available at lower cost.

Jackie

I believe Shannon advised me that if after my TEE I have to remain on NOACs I should ask to switch to Eliquis because it's a twice a day (shorter half life) rather than once a day Xeralto therefore is out of my system faster and safer if a life threatening bleeding event happens.

I tried Eliquis for a short period of time because I was having so many side effects from the xarelto. But I had worse side effects with eliquis and also twice a day instead of just in the evening. I seem to have adjusted to xerelto now and the side effects have calmed down, Other than a burning stomach. I take xarelto in the evening and so by the next day it has supposedly mostly left my system.

I was going to say that the rebound effect sounded like fear-mongering, but... the link to the paper posted actually seemed to support the Xarelto rebound theory. On the other hand, that paper (which was actually an Editorial Comment) is 2 years old. Since then, have there been any studies which support/refute the so-called xarelto effect? If not, then it's probably not real.

I've learned over the years (and MD's have confirmed) that you can find a published paper (or in this case, an Editorial) to support pretty much anything. So one single published paper is, unless supported by further evidence. Thus, unless there are other papers confirming the purported Xarelto rebound effect, I would discount it (ie, ignore it).

Regarding how long Xarelto says in one's system, MD's use the rule of 5 half-lives. Five half-lives is 1/2 * 1/2 * 1/2 * 1/2 * 1/2, which is 3%. In other words, after five half-lives, only 3% of the drug is still in your system.

And the half-life of Xarelto is documented:

Quote

Note that the half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.

Ref: [www.xareltohcp.com]

-Ted

I don't see the connection that Amyorca made between half-life of a drug, and the rebound effect when tapering off of a drug. When you taper off of a drug, your system body has a chance to gradually get used to the drug not being there. Whatever the the half-life of a drug is, would not negate the positive effects of the tapering, as you are still always introducing the drug again in your system, but at gradually lower doses.

The connection is... that Amyorca was worried about missing a dose, and thinking that missing 1 dose meant the effective drug concentration was zero. It's not. That only occurs after 5 half-lives. Which (depending on one's age) takes significantly longer than 24 hours. Either 5 * 7 = 35 hrs, or 5 * 12 = 60 hrs.

Mike E Wrote:
-------------------------------------------------------
> I'm on Xeralto but intend to get off as soon as
> possible. I found an article:
> [url=http://content.onlinejacc.org/data/Journals/J
> AC/926323/09056.pdf]Discontinuation of
> Rivaroxaban[/url]
>
> From the article:
>
> "Temporary interruptions of the study drug were
> associated with event rates of roughly 5 to 6 per
> 100 patient-years and did not differ between
> rivaroxaban and warfarin patients."
>
> I'm guessing this is a very low risk given the
> transistion time is only a few days? Hopefully
> someone else will add a better interpretation.
> Something else to worry about.

I think the 5 to 6 events per 100 patient years is for temporary interruptions, like stopping for 1-2 days to have dental work done. I think what Amyarco would be doing is what is referred to as early discontinuation, and the rate for that is 23-25 per 100 patient years.

Can we figure what the risk is per withdrawal from zarelto, based on 25 events per 100 patient years in this study?



Edited 2 time(s). Last edit at 08/14/2015 04:22AM by The Anti-Fib.

If you read to the end, the author's conclusion is somewhat reassuring: the patients in the ROCKET trial were at high risk of stroke anyway and the strokes occurred after Xarelto's anticoagulation effects wore off and before they were properly anticoagulated on warfarin:

"... the most likely explanation for the observed risk in the post-study transition period is not that rivaroxaban has some property resulting in a rebound effect, but rather that the high-risk patients enrolled in the ROCKET AF trial (mean age: 73 years, mean CHADS2 score: 3.5) had a substantial difference in anticoagulation coverage during this period, and the event rates merely reflect the unmasking of their underlying
risk."

Cathy

I read the study as well, it seemed inconclusive to me. I had my pharmacist call to xarelto physician line, and she was told that they really don't have the answers either and they are still doing testing. Comforting.....is there anyone on this site who have gone off xarelto and is able to talk about their experience?

I am still taking xarelto because now I am afraid to stop taking it.

I went off Xarelto after my second ablation when given the go ahead by Dr. Natale. If I get clearance to stop taking it after my upcoming TEE (I had a third ablation in Feb, LAA) I will stop without giving it another thought.

Quote

I am still taking xarelto because now I am afraid to stop taking it.

I've gone on/off Xarelto at least 8 times over the past 2 years, with the approval of my current EP (Dr. Robinson). No problems so far. Basically each time I get cardioverted I go on it for the following 30 days. On day 31, I stop. Until the next afib incident.

How often do you have afib? Why don't you just stay on Xarelto? Did your dr. give you any warning?

2 years.
No warning. Having read the docs in this thread, I don't think a warning is warranted.
I don't stay on it because I don't like staying on medication that's not necessary.

Yes, Mike - so will I... stop the Eliquis if I'm cleared. But I fully intend to resume all of the natural products that offer blood thinning properties and yet have none of the side effects of these NOACs and be monitored a couple times a year to be sure I'm low on inflammation and the other risk factors that promote adverse clotting.

Jackie

How do you get monitored to see if you have inflammation? How do you reduce the inflammation when you have it?

amyorca... the Cardiac or High Sensitivity C-reactive Protein test is the best indicator of inflammation...( HS-CRP) is the test to request... and the other risk factors for "thick, sticky blood" are covered in this report:

Sticky, thick blood - risk of stroke or MI
September 06, 2012 [www.afibbers.org]

Then go to this search result... and follow some of the posts regarding inflammation and so forth. [www.afibbers.org]

Just scroll through the titles and follow those that appear to be about inflammation and avoiding clotting.

Once off the Eliquis, I'll be stepping up my intake to where it was prior to that anticoagulant of the natural aids for both reducing inflammation and keeping blood naturally "thin and slippery".... ie, increasing Omega 3's to 4 - 6 grams a day,
Cardiokinase to lower fibrinogen levels, Ginkgo biloba, Curcumin, and several combination products known to help lower inflammation... I'm particular fond of Inflammatone by Designs for Health, as one example.

Jackie

Thank you I will look into this.

I went off Xarelto at 13 months post abaltion, now at 26 months afib free.
Had a stroke 4 years ago and technically I should still be on Xarelto.....but then again I went to Natale.


McHale



Edited 1 time(s). Last edit at 09/02/2015 10:11AM by McHale.