A Patient's guide to Rivaroxaban to Reduce Blood Clots Following Foot & Ankle Surgery

After a cut or injury, it is normal to bleed. Proteins in the blood help to form a clot to stop us from bleeding too much. Sometimes a clot can form in the wrong place.

People who have had surgery or cannot move around as much as normal are at an increased risk of blood clots forming in the wrong place.

Blood clots in the veins, usually in the legs is known as a deep vein thrombosis (DVT).

A Pulmonary Embolism (PE) is a piece of blood clot that has broken off and travelled to the lungs. It can cause lung damage and even death in a small number of people.

Anyone can develop a DVT or PE but you are at higher risk if you:

• Smoke
• Are overweight
• Are over 60 years old
• Have cancer
• Take the combined oral contraceptive pill or hormone replacement therapy
• Have ongoing medical conditions e.g. inflammatory bowel disease, chronic renal failure, congestive heart failure or chronic obstructive pulmonary disease (COPD)
• Have had a previous blood clot or have a first degree relative (parent/sibling) with a history of blood clots
• Are pregnant or had a baby in the last 6 weeks
• Have had major lower limb/orthopaedic surgery

You can help to reduce your risk of developing a blood clot by drinking plenty of fluids and moving around as much as you can-safely.

Your risk of developing a blood clot is higher than usual while you are immobile as your foot is in a cast or you are unable to place weight on it, and you have at least one of the risks listed above. Taking Rivaroxaban will reduce the risk of developing a blood clot.

Rivaroxaban is often used to prevent blood clots after hip/knee replacement surgery and in patients with an irregular heartbeat. It is also sometimes given as a treatment to people who have had recent blood clots, in order to stop new ones forming. However, it is not yet approved to prevent blood clots in patients with lower limb casts or those unable to weight-bear after foot and ankle surgery. It is important to note that this does not mean that it doesn’t work when patients have a cast, but rather that no large-scale studies have been done to assess this as yet.

One possible alternative treatment to Rivaroxaban is a type of medicine called Low Molecular Weight Heparin (LMWH). LMWHs have been used for a number of years but have to be injected daily and may be associated with other complications which require regular blood tests to monitor.

At RNOH, senior doctors and pharmacists have reviewed the data surrounding Rivaroxaban. Given that Rivaroxaban is effective in preventing and treating blood clots in a number of related situations, it has been deemed that it is safe to use Rivaroxaban in patients undergoing foot and ankle surgery. This is known as ‘off-label’ use.

Please talk to your surgical team or ward pharmacist if you have any concerns about taking Rivaroxaban. Any newly started medication will be checked by a pharmacist to ensure the medicine is right for you.

Rivaroxaban is available as a 10mg tablet. You should take one tablet once a day (with or without food) at the same time each day to help you remember to take it.

The whole course of treatment will be dispensed by RNOH Pharmacy.

You should continue taking your tablets until your plaster cast has been removed and you are able to weight-bear. Treatment is usually for a minimum of 2 weeks up to a maximum of 6 weeks.

Rivaroxaban can make bleeding last longer and be heavier. Some common side effects include nausea, stomach-ache, indigestion, headache or dizziness.

For more information on side effects-please refer to the information leaflet inside the box of your Rivaroxaban tablets.

Please tell your doctor or go to the nearest A&E if you notice any:

• Coughing up blood or coffee ground vomit
• Pink/brown urine or red/black stools
• Excessive bleeding or swelling from your wound or other injury
• Menstrual flow or vaginal bleeding that is heavier than usual
• Unexplained bruising, bleeding gums or nose bleeds
• Sudden, severe headache

There is a greater chance of developing blood clots if you do not take Rivaroxaban.

If you forget to take your tablets, take them as soon as you remember. If unsure whether you have taken your tablets, please take them the next day to avoid the risks of doubling-up on this medicine. Do not take more than one dose per day.

If you have taken more than one dose in 24 hours, seek same day advice from your doctor or call NHS 111.

Your GP will be notified of any changes to your medicines during your hospital stay.

Alert all other healthcare professionals involved in your care e.g. nurse, pharmacist or dentist that you are taking Rivaroxaban.

Ensure that you carry the alert card provided with your Rivaroxaban tablets with you at all times.

• Your nearest A&E department for any pain or swelling in one/both legs
• Call 999 immediately for any shortness of breath, chest pain or if you are coughing up blood.

Please refer to the information leaflet inside the box of Rivaroxaban tablets or speak with your ward pharmacist before you are discharged.