Saddle Thrombus Chf Clopidogrel And Xarelto

[hawaiian]

Aloha,

"Poki" survived a blood clot over 3 years ago and has been on 18.75mg clopidogrel and aspirin ever since. Her checkups are very encouraging as it seems she is responding well to the clopidogrel. My Vet office acquired a new cardiologist who suggested I drop and aspirin and add 2.5mg Xarelto. It is very expensive but I can get the drug from Canada and have is compounded and the cost would be manageable. Problem is that "Poki" also has Triaditis which is a liver/kidney disease. Seems that Xarelto may not be the best medication for a cat with liver issues. Is anyone else on Xarelto? Is it worth the risk for a cat with Triaditis?

 

[FeebysOwner]

Hi. I don't have any background with this, but just curious why this cardiologist would want to change up the meds Poki is currently on if they are working for her - and have not yet caused any adverse effects on her system.

Also, if I am not mistaken, isn't there a danger with Xarelto if your cat would have an accident that caused major bleeding? I don't think there is an approved antidote that can reverse Xarelto in such a situation. If you choose to change the drugs Poki is taking, ask the cardiologist & vet about this.

 

[hawaiian]

I think the bleeding is a characteristic of the clopidogrel and Xarelto. Poki's checkups has been great with only slight degrading of the heart. Of course, you can only slow down and process, not cure it. I'm ecstatic with her response to the clopidogrel and aspirin. My vet said that the aspirin does not work for cats as previously prescribed. That's why she want to switch the aspirin to Xarelto. I have read some about the Xarelto and see that it is a slightly different medication than clopidogrel. Seems it is the drug of choice for humans now as opposed to Warafin and clopidogrel.

Anyway, if the Xarelto adds years for her then I will do it in a heartbeat. I am worried about her liver reacting to the medication.

 

[FeebysOwner]

I think they have always had an antidote for clopidogrel, but I do know they did not use to have one for Xarelto. You are right in that the two drugs work differently in how they function as anti-coagulants - and that is why the antidote for clopidogrel is not effective for Xarelto. Please ask the vet/cardiologist about this aspect. And, even if they have an antidote for Xarelto for humans - make sure it is applicable to/available for cats too.

I also think that clopidogrel has effects on the liver too, but you can talk to the vet about the differences/similarities between the effects of each. If there is not that much difference and Xarelto has an antidote, then that should help alleviate some of your concern about changing Poki to a new drug regimen.

 

[FeebysOwner]

Hi again. Attached is an article about an antidote for which approval was delayed (in humans) by FDA, a year ago. I haven't yet found an update, but perhaps I so far have just missed it. Anyway, gives you something to address with the vet cardiologist about whether something of this nature is available for cats who are on Xarelto.

FDA Delays AndexXa Antidote for Xarelto Bleeding

 

[hawaiian]

Aloha Owner of Freeby,

Thank you for the enlightening information. I have never linked clopidogrel and her triaditis. In searching the two, it seems that there are issues with clopidogrel and liver function. Poki's Triaditis flared up about a year after she started clopidogrel. I thought it was just a "side effect" of her heart condition and often wondered what other issues will occur next. I think my vet should have caught this awhile back.

With the above information it actually pushes me closer to trying the medication. Perhaps her Triaditis medications (milk thistle, budestonide and urdodial) can keep the liver functions normal. My vet suggested we do a blood test now before we start treatment and another 2 weeks after. My fear is that it does irreparable damage within the two weeks or sometime after that.

......what to do...?

 

[FeebysOwner]

I think all of those type meds (anti-coagulants) have an effect on the liver. The key is whether or not Xarelto is any better/worse than clopidogrel in terms of liver effects. Besides asking the vet for study information and/or their knowledge of the effects when comparing them, wonder what would happened if you tried an internet search comparing the two?

Liver function tests before and then two weeks after starting Xarelto would at least tell the vet whether or not Xarelto was affecting the liver more than clopidogrel has. I am guessing that the vet has records of Poki's liver tests over the course of treatment? Maybe s/he could share those with you?

 

[hawaiian]

I have not yet decided which way to go. A little more insight to this is that the new cardiologist originally said that the aspirin that Poki was prescribed to as a supplement to clopidogrel was found to be ineffective on cats. She said to replace the aspirin with Xarelto. After I was hesitant with the Xarelto, she suggested I go back to the aspirin. ? Why would I go back to the aspirin if it was ineffective for cats? So in my pessimism, I'm thinking "Do vets get a kickback on prescribing medications?". I she prescribing me this very expensive medication because she gets a kickback from the pharmaceutical company? I believe medical doctors do. Is the prescription of clopidogrel and Xarelto really that effective? I have searched the internet for using both medications and I have found nothing.

 

[FeebysOwner]

Hi. I am sure that vets (just like human doctors) do use certain drugs because of their exposure to sales representatives who routinely visit with them to encourage the use of certain drugs that they represent. Whether or not kickbacks are involved, I don't know. But, vets and doctors do get samples to administer if the agree to support the drug.

There are some articles/information about each of the drugs you noted above, but they are mostly published by pharmacies - which is what I suspect you were referring to when you said you found nothing on the internet.

However, interestingly enough, I found a clinical trial going on (which unfortunately doesn't end until August 2019) that is comparing the use of clopidogrel and Xarelto in cats, by the University of Georgia. I did not find any trial that has been completed, but there may be others out there and I just did not come across them.

http://veterinarynews.dvm360.com/take-heart-two-new-studies-shed-light-arterial-thromboembolism
Study of the Utility of Rivaroxaban or Clopidogrel for prevention of recurrent Arterial Thromboembolism in cats (SUPERCAT)

I also found some articles about trials conducted to compare clopidogrel to aspirin (one or the other drug, but not both together). The results all pointed to clipidogrel being the better choice. But, I didn't find a whole lot about studies done using both at the same time. I think from what I read, the default treatment was a combination of both based on previous/older studies/trials.

I know none of this really helps you. So, after all that, in case it wasn't mentioned before, you might want to try joining this group to see if you can find others who have some personal history/background with Saddle Thrombus: Yahoo! Groups

 

[hawaiian]

Aloha again, owner of Feeby,
Yeah, I've seen that SuperCat trial but I believe its closed now and you don't know if you get the Xalrelto or Clopidogrel. I just want to see other cat owners who have been on both Xarelto and Clopidogrel. I have never seen anyone on both. Mahalo for you time.

 

[FeebysOwner]

I didn't mean to suggest you could get into the trial - but, just wanted you to know that comparing the two meds to see which is more effective is apparently pretty new. I know it doesn't help you at this point, and I wish the study was closer to the end so that you could have some valuable information from it.

Threads on this site stay closer to the top of all the posts if there are new posts made frequently. So, my post here should place your thread closer to the top and hopefully will help more members read it and respond!!

BTW - did you check out the Yahoo group I mentioned above?