Xarelto, Coumadin or Warafin management and physician mistakes

Xarelto, Coumadin or Warafin management and physician mistakes

Xarelto, Coumadin or Warafin management and physician mistakes 150 150 Lauren Ellerman

I have heard it before: “This new medication is so far superior to what we used in the past. It’s easier to manage, blah blah blah blah blah.”

While I love the optimistic health care providers have about new drugs, I have and will remain a skeptic.

Coumadin has long been a difficult medication to manage in patients. There is a black box warning (which means VERY IMPORTANT – RISK – READ NOW – DOCTORS BEWARE) from the FDA on Coumadin which states:


Warfarin sodium can cause major or fatal bleeding. Bleeding is more likely to occur during the starting period and with a higher dose (resulting in a higher INR). Risk factors for bleeding include high intensity of anticoagulation (INR >4.0), age 65, highly variable INRs, history of gastrointestinal bleeding, hypertension, cerebrovascular disease, serious heart disease, anemia, malignancy, trauma, renal insufficiency, concomitant drugs (see PRECAUTIONS), and long duration of warfarin therapy. Regular monitoring of INR should be performed on all treated patients. Those at high risk of bleeding may benefit from more frequent INR monitoring, careful dose adjustment to desired INR, and a shorter duration of therapy. Patients should be instructed about prevention measures to minimize risk of bleeding and to report immediately to physicians signs and symptoms of bleeding (see PRECAUTIONS: Information for Patients).

Yikes. Pretty heavy stuff. Try to put that in a commercial with people holding hands on the beach.

So when I hear family members, clients and patients claim their doctors are no longer using Coumadin but have started using Xarelto (Za-rol-toe) to manage coagulation of their blood, my back and neck tense up a little bit.

Is this new medication the Knight in Shining Armor we have all been waiting for? Or does it too come with risks and benefits and require physicians to be extra vigilant?

Our firm is currently handling cases where physicians have mismanaged Xarelto and Coumadin to the detriment of their patients. Sadly, we see this a lot with Coumadin – physicians fail to order PT/INRs, or adjust doses accordingly, or warn of the interactions with other drugs like antibiotics, etc.

The packaging for Xarelto warns for increased risk of stroke, bleeding and spinal hematomas. Big scary conditions that really warrant and active and education physician’s management.

So, time will tell whether this new medication is really what we hope it is. In the meanwhile, any drugs that are prescribed to help your blood clot, requires hands on physician management and care.

And if any of these events happen to you or your loved one in Virginia, while on an anti-coagulant (such as Coumadin, Warafin, Lovenox or Xarelto) we would be happy to help investigate whether the event occurred because of health care negligence:

  • stroke
  • fall
  • bleed / hematoma
  • death

No one wants to have a lawsuit. No one wants to be the victim of negligence, we understand. We also understand how devastating a preventable loss or injury can be.



About the author

Lauren Ellerman

In 2011, Lauren Ellerman was named "Young Lawyer of the Year" by the Roanoke Bar Association for her work in the community. To speak with Lauren about your personal injury case, contact her at lellerman@frithlawfirm.com.

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