General Medical issues thread

[Quickstatus]

Risk of bleeding still high.

Lower than warfarin in most cases but higher than no blood thinners.

warfarin is specific to being post mitral valve repair, rather than the AF.

Yes, specifically metal valves, though not exclusively - some people can't do rivaroxaban.

 

[TheRealTMA]

Lower than warfarin in most cases but higher than no blood thinners.


Yes, specifically metal valves, though not exclusively - some people can't do rivaroxaban.

That’s what the big bucks you pay to the cardiologist are for.

 

[Pushka]

Xarelto isn’t currently reversible. That’s the main risk. Warfarin is. But as my mum died on warfarin just 6 weeks before my jugular vein dvt I was very pleased that they prescribed xarelto in the hospital.

 

[prozac]

Xarelto isn’t currently reversible. That’s the main risk. Warfarin is. But as my mum died on warfarin just 6 weeks before my jugular vein dvt I was very pleased that they prescribed xarelto in the hospital.

That's right and now you remind me the vascular surgeon said if I had an accident and had internal bleeding then there was no antidote to reverse the Xarelto function.

 

[Gladstone Tim]

I’ll preface this by saying I will speak to my GP but don’t fancy shelling out the $50 gap just now. Two years ago during an ultrasound for an unrelated matter a large stone was found in my gall bladder. As it was asymptomatic, I have chosen since then not to do anything about it (apart from declaring it on travel insurance and paying the surcharge). I’ve recently had hernia surgery and the surgeon painted a dire picture if I don’t have the gall bladder removed. He cited how on the previous Saturday whilst on-call he had completed three emergency gall-bladder removals with patients in perilous conditions. Now my ICU nurse daughter has told my wife that complications of the surgery can be serious and chronic e.g. diarrhoea. Do any fellow AFFers have experience?

 

[Seat0B]

I’ll preface this by saying I will speak to my GP but don’t fancy shelling out the $50 gap just now. Two years ago during an ultrasound for an unrelated matter a large stone was found in my gall bladder. As it was asymptomatic, I have chosen since then not to do anything about it (apart from declaring it on travel insurance and paying the surcharge). I’ve recently had hernia surgery and the surgeon painted a dire picture if I don’t have the gall bladder removed. He cited how on the previous Saturday whilst on-call he had completed three emergency gall-bladder removals with patients in perilous conditions. Now my ICU nurse daughter has told my wife that complications of the surgery can be serious and chronic e.g. diarrhoea. Does any fellow AFFers have experience?

Ah the old medical cough sandwich. I hope you can get enough info to make a sound decision @Gladstone Tim.

 

[Quickstatus]

Xarelto isn’t currently reversible

Yes it is but mostly avail in tertiary referral hospitals

Andexxa
Beriplex

 

[Quickstatus]

large stone was found in my gall bladder.

Gall bladder stones can block the drainage of the gall bladder causing bad infections necessitating removal. A large stone is not an issue because it can't block the drainage of the gall bladder. However the question is whether there are also smaller sized "gravel" that can.

The cons of gall bladder surgery are real. The cons of emergency gall bladder surgery (compared to elective) are worse

 

[Pushka]

I’ll preface this by saying I will speak to my GP but don’t fancy shelling out the $50 gap just now. Two years ago during an ultrasound for an unrelated matter a large stone was found in my gall bladder. As it was asymptomatic, I have chosen since then not to do anything about it (apart from declaring it on travel insurance and paying the surcharge). I’ve recently had hernia surgery and the surgeon painted a dire picture if I don’t have the gall bladder removed. He cited how on the previous Saturday whilst on-call he had completed three emergency gall-bladder removals with patients in perilous conditions. Now my ICU nurse daughter has told my wife that complications of the surgery can be serious and chronic e.g. diarrhoea. Do any fellow AFFers have experience?

My Dad had emergency surgery for gall bladder. It didn't go well. I don't know what happened at the time but understand perhaps it ruptured and spilled into his abdomen causing a major infection. I don't know if he knew it was there before. He was really ill for a while. I don't think he actually got over it because a couple of years later he developed cancer of the bile duct (don't know why it wasn't removed at the time?) and then another major surgery which was only successful for 12 months.

 

[RooFlyer]

Yes it is but mostly avail in tertiary referral hospitals

Andexxa
Beriplex

What do you call a tertiary referring hospital? Why would it have a limited distribution?

I’m on Xarelto for life as a precaution against afib even though I’ve had an ablation procedure. Continuing big worry for me.

 

[Pushka]

What do you call a tertiary referring hospital? Why would it have a limited distribution?

I’m on Xarelto for life as a precaution against afib even though I’ve had an ablation procedure. Continuing big worry for me.

Just googling but it seems they can cause blood clots and the research isn't strongly out yet. I'm on X too and have been for 10 years. Apart from the odd weird bruise, and don't ever get a cut on your tongue like I did and won a trip in an ambulance, no problems. Well. Fewer problems than me getting another DVt as I get them in scarey places.

 

[RooFlyer]

Just googling but it seems they can cause blood clots and the research isn't strongly out yet.

For sure. I asked the cardiologist if I could just take it when I know I’m in afib (130+ BPM) he said no, not really, because it could happen in your sleep.

 

[Quickstatus]

What do you call a tertiary referring hospital? Why would it have a limited distribution?

Royal Hobart is a tertiary referral hospital
These products are high cost and not funded through the PBS so are not generally kept as a general medicine at a pharmac_
Mainly the tertiary hospitals keep them especially Beriplex though they are available through the Red Cross transfusion service for any hospital
it is given by infusion in a hospital only and require an approval by an on call haematologist.

Andexxa is estimated to be double? the cost of a Ponant Antarctic cruise
Beriplex about $350 a vial but often need a few vials.
Mostly they will try Beriplex first.

it could happen in your sleep.

Xarelto takes maybe about 2 hours to start working.
Reasonable question though. Are you aware when the AF starts? Some people don't feel it.
There are wearable devices that can potentially detect AF.

 

[Pushka]

Royal Hobart is a tertiary referral hospital
These products are high cost and not funded through the PBS so are not generally kept as a general medicine at a pharmac_
Mainly the tertiary hospitals keep them especially Beriplex though they are available through the Red Cross transfusion service for any hospital
it is given by infusion in a hospital only and require an approval by an on call haematologist.

Andexxa is estimated to be double? the cost of a Ponant Antarctic cruise
Beriplex about $350 a vial but often need a few vials.
Mostly they will try Beriplex first.

Xarelto takes maybe about 2 hours to start working.
Reasonable question though. Are you aware when the AF starts? Some people don't feel it.
There are wearable devices that can potentially detect AF.

wow. Andexxa (andexanet alfa) is a high-cost reversal agent for rivaroxaban and apixaban, generally costing between US $24,750 and $49,500 per treatment course

 

[Quickstatus]

we can't use it unless we have tried Beriplex first and optimised every physiological thing that promotes clotting first.

I would be scared to drop it accidentally

 

[Pushka]

we can't use it unless we have tried Beriplex first and optimised every physiological thing that promotes clotting first.

I would be scared to drop it accidentally

How long does Xarelto last? If having a blood test I don't take it before I go, so that's over 24 hours but the phlebotomist always asks if I'm on it. My blood tests are very quick

 

[TheRealTMA]

How long does Xarelto last? If having a blood test I don't take it before I go, so that's over 24 hours but the phlebotomist always asks if I'm on it. My blood tests are very quick

There's usually no issues with Rivaroxaban and blood tests, at least for me it's no issue. I tell the collector and she uses a smaller needle and slightly different proceedure. YMMV.

FWIW: From what I read it lasts 24-28 hrs after the last dose.

 

[Pushka]

There's usually no issues with Rivaroxaban and blood tests, at least for me it's no issue. I tell the collector and she uses a smaller needle and slightly different proceedure. YMMV.

FWIW: From what I read it lasts 24-28 hrs after the last dose.

Yes. I've had them every month for the last 3 years to monitor inflammation markers.

 

[Quickstatus]

How long does Xarelto last

If someone is having surgery and no kidney impairment stop 2 days prior
For neurosurgery maybe stop 72hrs prior
Certainly the peak effect is about 2 hours after taking the pill.

Can't test for Xarelto/rivaroxaban with usual blood tests - need special tests but even with those tests, the results and not necessarily correlated with bleeding risk.

 

[SuePa]

I’ll preface this by saying I will speak to my GP but don’t fancy shelling out the $50 gap just now. Two years ago during an ultrasound for an unrelated matter a large stone was found in my gall bladder. As it was asymptomatic, I have chosen since then not to do anything about it (apart from declaring it on travel insurance and paying the surcharge). I’ve recently had hernia surgery and the surgeon painted a dire picture if I don’t have the gall bladder removed. He cited how on the previous Saturday whilst on-call he had completed three emergency gall-bladder removals with patients in perilous conditions. Now my ICU nurse daughter has told my wife that complications of the surgery can be serious and chronic e.g. diarrhoea. Do any fellow AFFers have experience?

Can I just say, my 84 year old mother had her gall bladder removed via keyhole surgery, last year. She was in hospital overnight, had 1 injection for pain relief that night and took 1 Panadol the next day and that was it.
I know things don't always go that way, but maybe, it's not as bad as you are perhaps anticipating.
My thoughts ( with absolutely no medical knowledge! ) are why wait until it becomes an issue?