Rivaroxaban to prevent blood clots if you have a lower limb injury

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What is this information about?

Your doctor has prescribed a tablet called rivaroxaban. Rivaroxaban is a blood thinner that reduces the risk of getting a blood clot while you cannot move around because of your injury.

This information tells you about rivaroxaban and what it is for. It also tells you about the risk factors for getting a blood clot; side effects of rivaroxaban; and how rivaroxaban is used.

Why have I been given this information?

It is important to take rivaroxaban safely, and this information will help you to know how and when to take it. It also tells you what to do if you take the wrong dose.

This information also tells you about the symptoms of a blood clot. Blood clots can be dangerous and it is important to know what the symptoms are if you are at risk of getting them.

Please keep this information in a safe place so you can refer to it if you need to.

What is a blood clot?

Venous thromboembolism is a blood clot that forms in a vein. It is also known as VTE. There are two types of VTE: 

• Deep Vein Thrombosis (DVT). A DVT is a blood clot (also known as a thrombosis) that forms in a deep vein, most commonly in the legs.
• Pulmonary Embolism (PE). If all or part of the DVT breaks free and passes through your blood vessels, it can reach your lungs. This is called a pulmonary embolism. 

DVTs and PEs often occur in people who are moving around less than they usually do. This can happen when you are not weight bearing as much as normal.  

Weight bearing means being able to support the weight of your body through your leg or legs.

What are the signs and symptoms of a DVT?

Symptoms of a DVT can include:  

• swelling
• redness or discolouration
• warmth and tenderness or pain in your leg. This may be worse when you are standing or walking.  

Sometimes there are no symptoms except pain.

DVTs can cause long term complications such as permanent leg swelling, leg ulcers, painful or aching legs and changes in skin colour.

What are the signs and symptoms of a PE?

Symptoms can include:

• coughing 
• chest pain 
• breathlessness 
• blood-stained phlegm 
• collapse.

What is rivaroxaban and what does it do?

Rivaroxaban is used to prevent blood clots. This includes deep vein thrombosis or pulmonary embolism.  

It is an anticoagulant. This means that it thins the blood. Taking rivaroxaban will reduce your chances of getting a blood clot.

Why has rivaroxaban been prescribed for me?

You have been prescribed rivaroxaban because your risk of having a blood clot is higher than usual. This is because you cannot weight bear at the normal level because of an injury.  

You may also be at higher risk than other people because of other things to do with your health. These are called risk factors. These include:

• a past history of blood clots 
• you have been, or are being treated for, cancer 
• being overweight 
• not walking or moving around (reduced mobility) 
• taking combined contraceptives (the contraceptive pill, the contraceptive patch or the vaginal ring.
• you are on hormone replacement therapy (HRT) 
• you have had recent surgery, especially on hips or knees
• you are over 60 years old 
• in the last six weeks, you have experienced: termination of pregnancy, miscarriage or given birth 
• you are dehydrated (have not drunk enough) 
• you smoke 
• you have varicose veins with phlebitis (inflammation of the vein) 
• a close relative has had a blood clot 
• you have thrombophilia (inherited blood clotting disorders) 
• long distance travel.

If you think that any of these risk factors apply to you, talk to your hospital doctor.

Are there any reasons why I should not take rivaroxaban?

You must not take rivaroxaban if you are pregnant or have severe problems with your kidneys.  

Do not take rivaroxaban if you are breastfeeding. Please discuss with your doctor.  

There are other medicines that should be used instead, such as heparin injections.

Are there any side-effects with rivaroxaban?

Because rivaroxaban affects the clotting of your blood, it can make you bleed more easily. 

While you are taking rivaroxaban tablets you must seek medical help straight away if you have any bleeding, especially if you have any of the following:

• coughing or vomiting blood  
• black stools (poo) or blood in your stools                                         
• severe, persistent headache 
• dizziness or weakness  
• fall or injury to your head or face  
• blood in your urine (wee) 
• unexplained or severe bruising  
• heavy or persistent nose bleeds
• heavier periods that make you feel unwell
• other unexpected or uncontrollable bleeding.

You should tell a nurse or doctor as soon as possible if you notice:

• you are bruising more easily than you normally do 
• you feel more weak, tired or short of breath than normal.

The rivaroxaban packet will also come with an information leaflet. This will give you further details about the side effects of rivaroxaban. Please read this for more information.

What else should I know about rivaroxaban?

Rivaroxaban has been licensed to prevent blood clots in people who have had surgery (for example, hip or knee replacement surgery), people who have an irregular heartbeat, or people who have a new blood clot.  

Rivaroxaban has not been licensed to prevent blood clots in people with lower limb immobilisation (not being able to move your leg or legs freely).  

At this hospital, senior doctors and pharmacists have decided that it is safe to use rivaroxaban in this way. 

You may hear this called off label or unlicensed use of rivaroxaban. 

You can find information on why some medicines are unlicensed and what this might mean for you on the NHS website at: http://www.nhs.uk/Conditions/Medicines-information.

What if I do not want to use rivaroxaban?

If you do not want to take rivaroxaban, talk to your doctor, nurse or pharmacist. There are other medicines that could be used, such as heparin injections.

What will happen if I don’t take rivaroxaban?

Using rivaroxaban does not guarantee that you will not get a blood clot. But if you do not take rivaroxaban then there will be more chance that you get a blood clot while you cannot move around and support your body’s weight through your legs.

How much rivaroxaban should I take?

Rivaroxaban comes as 1Omg tablets. You should take one tablet each day, usually in the evening. 

You should carry on taking the tablets until your plaster cast has been removed, unless a healthcare professional tells you to stop it earlier. 

The clinician will prescribe enough tablets to complete your course of treatment.

What should I do if I take more rivaroxaban than I should?

If you have more than one dose in a day, then you can discuss with a pharmacist or your doctor.

What should I do if I forget to take my medication?

If you remember the same day, then take the dose. If you remember the next day, then take your dose when it is next due. Do not take more than one dose a day.

Do I need to tell my doctor about other medication I am taking?

Yes. Please tell your doctor if you are taking any other medicines, including any medicines that you have bought without a prescription.

How should I store this medicine?

Store the tablets in a cool dry place (not in the fridge). Keep them away from children and animals.

Where can I find out more information?

You will find more information in the package leaflet in the box of rivaroxaban tablets.