One of the most worrisome problems for surgeons is known as venous thromboembolism (VTE) – blood clots such as deep vein thrombosis and pulmonary embolism. These can occur after long operations, even in seemingly healthy people – and can be a life-threatening problem. In the past, we’ve used compression stockings, pneumatic sequential compression devices, or injectable blood thinners, like heparin and lovenox, to successfully reduce, but not completely eliminate, the risk of VTE’s. However, these therapies have been awkward to use, especially for outpatient surgery.
Now, the FDA is looking at approving a new medication that may be very helpful with this problem. Called Xarelto, it’s a once a day tablet. Technically speaking, it is classified as a direct Factor Xa inhibitor. According to the studies, it works as well or better than its injectable cousins (like lovenox) at preventing VTE. And unlike Coumadin, xarelto doesn’t require frequent blood tests to get the dose right. As an oral medication, it would be easy to patients to continue on this therapy at home, while they are recovering from surgery.
Barring side effects, Xarelto could be a real breakthrough for patient safety. In the field of Plastic Surgery, the obvious application would be for abdominoplasty (tummy tucks), where the risk of VTE is significant. The optimal dosing schedule for plastic surgery patients hasn’t yet been worked out.
The drug is approved in Europe. We’re hoping for FDA approval soon.