a patient`s guide to pulmonary embolism treatment

A PATIENT’S GUIDE
TO PULMONARY
EMBOLISM
TREATMENT
This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get any side effects, talk to your
doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the
Yellow Card Scheme at www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.
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Personal Information
Name:
Address:
Contact details:
Emergency contact details:
NHS number:
Name of consultant:
GP surgery:
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FOREWORD
It is human nature to have questions when we come
across or try something new. When something new
is related to our health, it’s even more important
that we have access to the information we need to
enable us to feel comfortable.
If you are preparing to use Xarelto (rivaroxaban) for the
treatment of pulmonary embolism (PE) and the prevention
of a recurrent PE and deep vein thrombosis (DVT), you
are likely to be curious as to what it is, how it works and
how often you will need to take your medication.
Working in collaboration with key patient organisations,
Bayer HealthCare have developed Xarelto Xpert, helping
you understand and better manage your condition. By
following our five step plan this leaflet will help you
become an ‘expert’ by:
•
•
ploring your condition
roviding you with information on Xarelto and how
it works
• xplaining how to take Xarelto
• evealing answers to frequently asked questions
•
aking you to other useful sources of information
We hope this leaflet helps you to feel confident about
taking the next step in your treatment journey with
Xarelto. Please read the Patient Information Leaflet for
further information on Xarelto.
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WHAT IS A PE?
A PE is a serious, potentially life-threatening
condition. It is due to a blockage in a blood vessel
in the lungs.
A PE is usually the result of an underlying blood clot in
the leg known as a DVT. The clot breaks away and travels
through the body, via the heart to reach the lungs.
When the clot reaches the lungs, it travels through the
vessels of the lung until it reaches smaller vessels where it
becomes wedged. The clot may then prevent any further
blood from travelling to that section of the lung.
It is estimated that PE occurs in around 3-4 people per
10,000 in the UK each year.1
The diagram on page 4 helps illustrate a PE.
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A PE occurs in around
3-4 people per 10,000
in the UK each year.
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A DVT is a blood clot that
forms in the veins deep
in your leg, usually in the
calf or thigh
The diagram above
explains how a DVT
and PE can occur.
Why does blood clot?
Blood clots occur as a vital protection system in our body.
When we injure or cut ourselves, a clot is formed outside
of our veins to protect us from the loss of blood. This is a
natural process known as the clotting cascade.
However, there are times when the clotting cascade goes
wrong and blood clots form inside our veins, causing a DVT
or PE. A PE often occurs when part or all of a blood clot from
one of the deep veins in your legs travels into your lungs.
What is a venous thromboembolism (VTE)?
VTE is the process by which blood clots occur and travel
through the veins. VTE is the collective term for DVT and PE.
What are the causes and symptoms of a PE?
Nearly all cases of PE are caused by a DVT, but PE can occur
without evidence of a DVT. It is estimated that about 1 in
1,000 people have a DVT each year in the UK. If untreated,
about 1 in 10 people with a DVT will develop a PE.2
Risk factors for developing a DVT and a PE include:
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A clot which has travelled
up from the leg to lodge
within the lung is known
as a PE
• age – older people are more likely to have a DVT than
younger people
• immobility caused by long travel journeys, illnesses or injuries
• having a recent operation
• pregnancy
• having severe pre-existing medical illnesses such as
cancer, heart problems or respiratory disease
• previous experience of a DVT or PE
• taking hormone-based treatment, such as the
contraceptive pill and hormone replacement therapy
• obesity
• genetic clotting disease
• smoking
PE can be life
threatening, so if
you are concerned
seek the advice of
a doctor or go to
the nearest A&E
department.
The common symptoms of a PE include:
• chest pain that is sharp and is worse when taking a deep breath
• shortness of breath
• coughing – which is usually dry, but may include coughing
up blood or mucus that contains blood
• sweating
• feeling light-headed or dizzy
• passing out
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How is a PE diagnosed?
Diagnosing a PE can be difficult because the signs and
symptoms vary between individuals and are common to
many other conditions.
Tests to diagnose a PE include:
• A chest X-ray
- An X-ray will show an image of the inside of your
chest and will detail whether a clot has formed
in the lungs
• D-dimer test
- D-dimer is a protein that is found in the blood after
a blood clot has broken down
- If a blood test shows a high level of D-dimer, it means
that pieces of a blood clot could be loose in your
blood stream and may become lodged in your lung
• Computed tomography pulmonary angiography
(CTPA)
- During a CTPA, dye is injected into the blood vessels
of your lungs and a CT scan is taken
- A CT scan is an X-ray that creates a very detailed
image of the inside of your body
- If there is a PE in one of your lungs, it will show up
as a gap in your blood supply
• Ventilation or perfusion scan
- This scan measures the amount of air and the blood
flow in your lungs
- If this shows that part of your lung has air in it, but
no blood supply, it may signify a PE
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How is a PE treated?
It is essential to treat a PE as quickly as possible.
Anticoagulation treatment will usually be given to you
– this is a type of medication that slows down your
body’s ability to clot therefore reducing the likelihood
of dangerous blood clots forming in your veins.
However, in the case of a massive PE, thrombolytic
treatment may be recommended – this medication
works by breaking down the clot.
Your doctor will discuss your treatment options in
more detail with you.
Can a PE be prevented?
PE can be prevented. However, not all DVT and PE can
be prevented as some can occur ‘unprovoked’ by no
known risk factors.
A PE is usually the result of an underlying blood clot in
the leg known as a DVT. Preventing a DVT, therefore, is
an important consideration for your doctor, particularly
if you are admitted to hospital for an extended period
or having surgery, or have previous experience of a
DVT. You may be given an anticoagulant drug to help
slow down your body’s ability to clot, and also asked
to wear compression stockings.
You can also help prevent a DVT by keeping mobile. If
you are going on a long journey, such as coach, train
or car, or sitting for any lengthy period, keep hydrated
and try to take regular breaks to stretch your legs and
feet to help your circulation.
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A STEP- BY- STEP
GUIDE TO XARELTO
You have been
prescribed Xarelto
to treat your PE or
suspected PE and to
also prevent further
clots from reoccurring
in your veins and
spreading to your
lungs.
What is Xarelto?
Xarelto is an anticoagulant, which is a type of
medication that slows down your body’s ability to
clot, therefore reducing the likelihood of dangerous
blood clots forming.
How does Xarelto work?
The formation of a blood clot is a natural process (called
the clotting cascade) within your body. For example,
when you cut yourself, you will see a clot form to stop
the bleeding.
Xarelto belongs to a group of medicines called
antithrombotic agents. It works by blocking a specific
protein in the blood – Factor Xa (‘ten A’) – which is
known to play a key role in starting the blood clotting
cascade process. Blocking Factor Xa prevents the
formation of subsequent proteins that are also involved
in the clotting cascade, so reducing the tendency for
blood clots to form.
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When the lining of the blood vessel becomes
damaged, platelets are activated at the site
to help prevent further injury
The clotting cascade
is activated to form
a blood clot
Activates
Activates
Becomes
Pt
Pt
Proteins
Xarelto works
by blocking
Factor Xa,
so reducing
the ability
for blood
clots to form
Factor Xa
Activates
Pt
Pt
Pt
Activates
Pt
Pt
Prothrombin
Thrombin
Fibrinogen
Xarelto
The illustration above will help you better understand how
Xarelto works.
How is Xarelto taken?
Xarelto is taken by mouth (orally) and the usual dose
for the treatment of PE and prevention of PE and DVT
is one 15mg tablet twice a day for the first three weeks,
followed by one 20mg tablet once a day thereafter.
The tablet should be swallowed whole, preferably with
water, and taken together with a meal. Try to take it at
the same time each day to help you remember it.
Xarelto does not have any special storage conditions,
however, keep it out of the reach and sight of children
and do not use Xarelto after the expiry date (which is
provided on the pack).
Fibrin - glue
that binds platelets
together to form a
blood clot
Xarelto is used to
treat different patients
for different reasons.
Another person
prescribed Xarelto
may take a different
dose from you. Always
take Xarelto exactly
as your doctor has
told you and check
with your doctor or
pharmacist if you
are unsure of your
correct dose.
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YOUR XARELTO
QUESTIONS ANSWERED
What do I do if I miss a dose
of Xarelto?
If you are taking one 15mg tablet
twice a day and have missed a dose,
take it as soon as you remember. Do
not take more than two 15mg tablets
in a single day. If you forget to take a
dose you can take two 15mg tablets
at the same time to get a total of two
tablets (30mg) on one day. On the
following day, you should carry on
taking one 15mg tablet twice a day.
If you are taking one 20mg tablet
once a day and have missed a dose
of Xarelto take a tablet as soon as
you remember it. Do not take more
than one tablet in a single day to
make up for the missed dose. Take
the next tablet the following day
and then carry on taking one tablet
once a day.
What do I do if I take too much
Xarelto?
If you have taken too many Xarelto
tablets contact your doctor
immediately as taking too many
may increase your risk of bleeding.
What are the most common side
effects of Xarelto?
Like all medicines, Xarelto can cause
side effects. As we are all different
these will vary from one person
to another.
As Xarelto is an anticoagulant
medicine that slows down your
body’s ability to clot, a common side
effect is an increased risk of bleeding
– either external, visible blood loss
or internal bleeding inside the body.
Symptoms of bleeding include:
• unexplained dizziness or weakness
• swelling and discomfort
• sudden, severe headache
• unusual bruising, nosebleeds,
bleeding of gums, cuts that take a
long time to stop bleeding
• menstrual flow or vaginal bleeding
that is heavier than normal
• pink or brown urine, red or black
stools
• coughing up blood, or vomiting
blood or material that looks like
coffee grounds.
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If you have any symptoms of
bleeding, tell your doctor or
visit your nearest A&E
department immediately so
that you can be monitored and
have your treatment assessed.
For a full list of possible side
effects, please refer to the
Patient Information Leaflet
provided with your Xarelto
tablets. If you think you are
experiencing side effects from
Xarelto at any time, contact
your doctor or pharmacist
immediately for advice.
Please remember to take
Xarelto every day – missing
a dose will increase your
risk of having a PE.
How long will I be treated with
Xarelto?
Length of treatment with Xarelto is
based on an individual assessment
of your risk factors and the benefits
of long term preventative treatment.
Your doctor will discuss this with
you and together agree the most
appropriate length of treatment.
Why does my dose for Xarelto
change?
You have been given a higher dose of
treatment with Xarelto during the
first three weeks as this will help to
treat your PE effectively. Your dose
is reduced thereafter as it will help
to prevent the reoccurrence of a PE
or DVT.
It is essential that you visit your
doctor after your initial three weeks
of treatment to ensure that your
condition is effectively managed.
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YOUR XARELTO
QUESTIONS ANSWERED
Will I be monitored during
treatment with Xarelto?
Unlike other anticoagulation
medicines (such as warfarin) which
have more food and drug interactions,
no blood test monitoring is required
when treated with Xarelto. However,
it is important that you attend
regular follow-up visits with your
doctor to assess and manage your
condition and monitor your
treatment with Xarelto.
Can I take other medications
with Xarelto?
Tell your doctor if you are also taking
other medications, even medicines
obtained without a prescription
(e.g. herbal remedies, vitamins,
over-the-counter medicines).
Will I bleed more if I have a cut
whilst taking Xarelto?
As Xarelto slows down your body’s
ability to clot, bleeding is a common
side effect. However, if you
experience excessive bleeding,
tell your doctor immediately.
What happens if I need to have
dental treatment or need to have
an operation whilst I am taking
Xarelto?
As Xarelto may increase your risk of
bleeding it is important that you
tell your dentist or doctor that
you are taking Xarelto before any
dental treatment or operations.
A patient alert card is provided at
the back of this leaflet which you
should carry with you at all times
and show in advance of any dental
treatments/operations to ensure
you are treated appropriately.
Do I need to avoid certain types
of food when using Xarelto?
No. Xarelto must be taken with
food and has no known food
interactions.
Can I drink alcohol whilst taking
Xarelto?
Xarelto does not interact with
alcohol. However, you should always
drink in moderation and stay within
the recommended guidelines.
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Can I take Xarelto if I am
intolerant to some sugars?
Xarelto contains lactose and you
should speak to your doctor if you
have a known intolerance to some
sugars before taking it.
Can I drive or operate
machinery whilst taking Xarelto?
Xarelto may cause fainting or
dizziness. If you experience these
symptoms you should not drive or
use machinery.
Can I take Xarelto if I am
pregnant or breastfeeding?
It is important that you discuss this
with your doctor as you must not
take Xarelto if you are pregnant or
breastfeeding. If there is a chance
that you could become pregnant,
it is essential that you use a reliable
contraceptive while you are taking
Xarelto. If you become pregnant
while you are using Xarelto, inform
your doctor immediately, who will
discuss your treatment options
moving forwards.
When should I not take Xarelto?
You must not take Xarelto:
• if you are allergic (hypersensitive)
to Xarelto or any of the other
ingredients of Xarelto
• if you are bleeding excessively or
are at risk of major bleeding
• if you have a liver disease which
leads to an increased risk of bleeding
• if you are taking any other
anticoagulant
• if you are pregnant or breastfeeding.
Speak to your doctor if any of these
apply to you.
How is Xarelto stored?
Xarelto does not have any special
storage conditions, however, keep it
out of the reach and sight of children
and do not use Xarelto after the
expiry date (which is provided on
the pack).
If you still have questions surrounding
the use of Xarelto please ask your
doctor who will be able to answer
these and provide you with more
information as appropriate.
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HOW TO USE YOUR
XARELTO PATIENT
ALERT CARD
Patient Alert Card
Xarelto® 2.5 mg
Xarelto® 15 mg
Xarelto® 20 mg
s Keep this card with you at all times
this card to every physician or dentist prior
s Present
to treatment
This medicine is subject to additional monitoring. This will
allow quick identification of new safety information. You can
help by reporting any side effects you may get. See the patient
information leaflet for how to report side effects.
This card is for use in the event of an emergency. A
doctor treating you will need to be made aware of the
existing medications you are on so that you can be cared
for appropriately. The attached alert card has been
designed to make the doctor aware that you are
receiving treatment with Xarelto. Please carry this with
you at all times.
In addition, please show your card in advance of any
dental treatment/operations to ensure you are treated
appropriately.
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USEFUL SOURCES OF
INFORMATION
To find out more about PE please visit the following
independent websites and organisations:
AntiCoagulation Europe (ACE)
Tel
020 8289 6875
Email
admin@anticoagulationeurope.org
Website www.anticoagulationeurope.org
Circulation Foundation
Tel
020 7304 4779
Email
info@circulationfoundation.org.uk
Website www.circulationfoundation.org.uk
Lifeblood: The Thrombosis Charity
Tel
01558 650222
Email
lifeblood.charity@googlemail.com
Website www.thrombosis-charity.org.uk
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MY NOTES
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MY NOTES
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MY NOTES
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REFERENCES
1. NHS information – Pulmonary embolism.
Available from:
www.nhs.uk/conditions/pulmonary-embolism/pages/
introduction.aspx
2. Patient UK – Pulmonary embolism. Available from:
http://www.patient.co.uk/health/pulmonary-embolism
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Developed as a service to patients
by Bayer HealthCare
Date of preparation: October 2014
L.GB.10.2014.8274
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