Xarelto and Stroke

Does Xarelto cause or prevent strokes? Why does the drug label state that it is used to “prevent strokes” yet it is also one of its side effects? Stroke is one of the most dangerous and deadly Xarelto adverse reactions, and one of the most compelling reasons why thousands of plaintiffs filed a lawsuit in the last few years. However, the drug’s label boldly states that rivaroxaban “can help reduce your risk of stroke” in patients affected by atrial fibrillation (Afib). Although this statement may apparently look as contradictory, both assertions are indeed true. In order to understand the reasons why rivaroxaban can both cause and prevent strokes at the same time, we need to dig a little deeper into what a stroke really is, and how does this medication actually works.

What is a stroke?

A stroke occurs when the supply of blood to an area the brain is cut off or reduced. Brain cells require a constant supply of oxygen and nutrients which are provided by the blood. When blood flow is interrupted, cells begin to die, causing temporary or permanent damage such as loss of memory, weakened muscle control or paralysis. Although some patients recover completely after a stroke, more than 65 percent of them will have to cope with some kind of long-term disability.

A stroke happens every time there’s an issue with the blood supply to the brain, such as when a vessel is blocked or it’s ruptured. There are three main types of stroke: ischemic, hemorrhagic and transient ischemic attacks (TIAs).


How does Xarelto prevent strokes?

blood clot

Xarelto is an anticoagulant, a substance that prevents blood clots from forming in your body by increasing the time it takes for blood to coagulate. One of its main indications is the prevention of stroke in patients who suffer from atrial fibrillation. If a thrombus does, in fact, clog a vessel carrying blood to the brain, an ischemic stroke may occur. Ischemic strokes are the most frequent type of stroke, accounting for about 87 percent of them all. If the blood flow is only briefly interrupted, then the damage is just temporary and does usually last for 24 hours. This type of stroke is known as transient ischemic attack (TIA).

When a blood clot is formed anywhere in the body, it may detach from its point of origin and travel to the brain. Once there, it may land on a small vessel blocking the blood flow causing an embolic stroke. Atrial fibrillation is often associated with a risk of embolic strokes because blood often clots inside the heart. This happens because irregular heartbeat keeps the four heart chamber called ventricles and atria from beating together in a regular pattern. As a result, blood pools in the atria instead of being pumped completely inside the ventricles, and its stagnation may lead to the formation of blood clots.


Why does Xarelto cause strokes?

brain bleeding and stroke

The second, less common form of stroke is the hemorrhagic one. Although it only accounts for 15 percent of all strokes, it is far more dangerous since it most often results in death. Hemorrhagic strokes happen when a brain artery leaks blood or burst open, causing nearby tissues to get flooded with blood. Spilled blood will then cause swelling and put pressure on brain cells, damaging and eventually killing them. If the stroke happens inside the brain, it is called intracerebral hemorrhage. If the bleeding occurs in the space between the brain surface and the tissues that cover it (usually because of a rupture in a weakened artery wall known as aneurysm), it is thus called subarachnoid hemorrhage.

Blood thinners such as Xarelto may increase the risk of life-threatening ruptures that lead to the aforementioned brain bleeding. Although medical literature only described a single intracranial hemorrhage case study of a patient who used this drug, hemorrhagic stroke is still one of the principal risks listed in this medication label. Just like all other uncontrolled bleeding events, cerebral bleeding can be an alarming side effect of the drug due to the absence of a proper antidote to reverse its action. All anticoagulants may, in fact, cause brain strokes, but differently to what happens with Vitamin K inhibitors such as Warfarin, if a patient is taking Xarelto, once the bleeding starts, doctors have no way to stop it. A cerebral hemorrhage may require hours to subside, and while physicians wait for the medication to be flushed out from the subject’s body, the damage caused could be either permanent or even fatal.

Bottom line, Xarelto can help reduce the risk of ischemic strokes in patients affected by AFib by thinning the blood and reducing the chance of a blood clot to form. At the same time, it may increase the risk of hemorrhagic strokes since all blood thinners are associated with aneurysms and subarachnoid hemorrhages. However, unlike other anticoagulants, Xarelto has no antidote to stop this last form of bleeding, making this type of stroke even more lethal.

Article by Dr. Claudio Butticè, Pharm.D.