When stroke risk hits home: The search for information

(BPT) – Teri Ackerson, a neuroscience nurse, and Paul Dippolito, a retired federal probation officer, have dedicated their lives to helping protect others. Now, to continue to help others, they also have to focus on protecting themselves, because they have a common heart condition called atrial fibrillation.

Atrial fibrillation, or AFib, is an irregular heartbeat that puts people at a <strong>fivefold</strong> increased risk of having a stroke. This is because blood may pool in the heart and form a clot, which can break free and travel to the brain. AFib affects nearly six million Americans, meaning many of our friends, neighbors, parents and grandparents are in danger of having a stroke, a leading cause of disability worldwide.

Teri was one of those people. One day while driving, she suddenly lost the ability to speak and mobility in her arm and face. As someone who specializes in stroke care, she immediately recognized the symptoms and went to the hospital. It was there that Teri learned she had nonvalvular AFib, which had caused her stroke. “Medicine is always advancing, so I learned all I could about my options to stay protected,” said Teri. “My doctor recommended a latest-generation blood thinner to help protect myself from having another stroke.”

Paul, on the other hand, found out he had AFib after waking up one morning and noticing a strange feeling in his chest. He immediately went to the doctor, where he learned he had the same serious heart condition and, like Teri, would need to be on a blood thinner to help protect him from having a stroke.

Teri and Paul know the value of protection and want to stay informed and knowledgeable about AFib in order to lead safe and healthy lives. They talked to their doctors and learned how XARELTO<sup>®</sup> (rivaroxaban) is selective and targets just one critical factor, interacting with less of the body’s natural clotting function than warfarin. It significantly lowers their risk of stroke.

For Teri and Paul, XARELTO<sup>®</sup> was the right choice to help protect them. To hear more about their stories and learn more about treatment with XARELTO<sup>®</sup> visit <a href=”http://www.MyAFibChoice.com” target=”_blank” rel=”nofollow”>www.MyAFibChoice.com</a>.

<strong>WHAT IS XARELTO</strong><strong><sup>®</sup></strong><strong>?</strong>

XARELTO<sup>®</sup> is a prescription medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation, not caused by a heart valve problem. For patients, currently well managed on warfarin, there is limited information on how XARELTO<sup>®</sup> and warfarin compare in reducing the risk of stroke.



<ul><li><strong>For people taking XARELTO</strong><strong><sup>®</sup> for atrial fibrillation:</strong><br />People with atrial fibrillation (an irregular heart beat) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. XARELTO<strong><sup>®</sup></strong> lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO<strong><sup>®</sup></strong>, you may have increased risk of forming a clot in your blood.<br /><br /><strong>Do not stop taking XARELTO</strong><strong><sup>®</sup></strong> <strong>without talking to the doctor who prescribes it for you. Stopping XARELTO</strong><strong><sup>®</sup></strong> <strong>increases your risk of having a stroke.<br /><br /></strong>If you have to stop taking XARELTO<strong><sup>®</sup></strong>, your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming.</li></ul><ul><li><strong>XARELTO<sup>®</sup> can cause bleeding</strong>, which can be serious, and rarely may lead to death. This is because XARELTO<sup>®</sup> is a blood thinner medicine that reduces blood clotting. While you take XARELTO<sup>®</sup> you are likely to bruise more easily and it may take longer for bleeding to stop.</li></ul>

You may have a higher risk of bleeding if you take XARELTO<sup>®</sup> and take other medicines that increase your risk of bleeding, including:

<ul><li>Aspirin or aspirin-containing products</li><li>Non-steroidal anti-inflammatory drugs (NSAIDs)</li><li>Warfarin sodium (Coumadin<sup>®</sup>, Jantoven<sup>®</sup>)</li><li>Any medicine that contains heparin</li><li>Clopidogrel (Plavix<sup>®</sup>)</li><li>Selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)</li><li>Other medicines to prevent or treat blood clots</li></ul>

Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above.

<strong>Call your doctor or get medical help right away if you develop any of these signs or symptoms of bleeding:</strong>

<ul><li>Unexpected bleeding or bleeding that lasts a long time, such as:<ul><li>Nosebleeds that happen often</li><li>Unusual bleeding from gums</li><li>Menstrual bleeding that is heavier than normal, or vaginal bleeding</li></ul></li><li>Bleeding that is severe or that you cannot control</li><li>Red, pink, or brown urine</li><li>Bright red or black stools (looks like tar)</li><li>Cough up blood or blood clots</li><li>Vomit blood or your vomit looks like “coffee grounds”</li><li>Headaches, feeling dizzy or weak</li><li>Pain, swelling, or new drainage at wound sites</li></ul>

<strong>Spinal or epidural blood clots (hematoma):</strong> People who take a blood thinner medicine (anticoagulant) like XARELTO<sup>®</sup>, and have medicine injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). Your risk of developing a spinal or epidural blood clot is higher if:

<ul><li>A thin tube called an epidural catheter is placed in your back to give you certain medicine</li><li>You take NSAIDs or a medicine to prevent blood from clotting</li><li>You have a history of difficult or repeated epidural or spinal punctures</li><li>You have a history of problems with your spine or have had surgery on your spine</li></ul>

If you take XARELTO<sup>®</sup> and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots. Tell your doctor right away if you have back pain, tingling, numbness, muscle weakness (especially in your legs and feet), or loss of control of the bowels or bladder (incontinence).

<strong>XARELTO<sup>®</sup> is not for patients with artificial heart valves.</strong>

<strong>WHO SHOULD NOT TAKE XARELTO<sup>®</sup>?</strong>

Do not take XARELTO<sup>®</sup> if you:

<ul><li>Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO<sup>®</sup> if you currently have unusual bleeding.</li><li>Are allergic to rivaroxaban or any of the ingredients of XARELTO<sup>®</sup>.</li></ul>


Before taking XARELTO<sup>®</sup>, tell your doctor if you:

<ul><li>Have ever had bleeding problems</li><li>Have liver or kidney problems</li><li>Have any other medical condition</li><li>Are pregnant or plan to become pregnant. It is not known if XARELTO<sup>®</sup> will harm your unborn baby. Tell your doctor right away if you become pregnant while taking XARELTO<sup>®</sup>. If you take XARELTO<sup>®</sup> during pregnancy, tell your doctor right away if you have bleeding or symptoms of blood loss.</li><li>Are breastfeeding or plan to breastfeed. It is not known if XARELTO<sup>®</sup> passes into your breast milk. You and your doctor should decide if you will take XARELTO<sup>®</sup> or breastfeed.</li></ul>

Tell all of your doctors and dentists that you are taking XARELTO<sup>®</sup>. They should talk to the doctor who prescribed XARELTO<sup>®</sup> for you before you have any surgery, medical or dental procedure.

<strong>Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.</strong> Some of your other medicines may affect the way XARELTO<sup>®</sup> works. Certain medicines may increase your risk of bleeding. <strong>See “What is the most important information I should know about XARELTO</strong><strong><sup>®</sup></strong><strong>?”</strong>

Especially tell your doctor if you take:

<ul><li>Ketoconazole (Nizoral<sup>®</sup>)</li><li>Itraconazole (Onmel<sup>™</sup>, Sporanox<sup>®</sup>)</li><li>Ritonavir (Norvir<sup>®</sup>)</li><li>Lopinavir/ritonavir (Kaletra<sup>®</sup>)</li><li>Indinavir (Crixivan<sup>®</sup>)</li><li>Carbamazepine (Carbatrol<sup>®</sup>, Equetro<sup>®</sup>, Tegretol<sup>®</sup>, Tegretol<sup>®</sup>-XR, Teril<sup>™</sup>, Epitol<sup>®</sup>)</li><li>Phenytoin (Dilantin-125<sup>®</sup>, Dilantin<sup>®</sup>)</li><li>Phenobarbital (Solfoton<sup>™</sup>)</li><li>Rifampin (Rifater<sup>®</sup>, Rifamate<sup>®</sup>, Rimactane<sup>®</sup>, Rifadin<sup>®</sup>)</li><li>St. John’s wort (<em>Hypericum perforatum</em>)</li></ul>

Ask your doctor if you are not sure if your medicine is one listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

<strong>HOW SHOULD I TAKE XARELTO<sup>®</sup>?</strong>

Take XARELTO<sup>®</sup> exactly as prescribed by your doctor.

<strong>Do not change your dose or stop taking XARELTO<sup>®</sup> unless your doctor tells you to.</strong>

<ul><li>Your doctor will tell you how much XARELTO<strong><sup>®</sup></strong> to take and when to take it.</li><li>Your doctor may change your dose if needed.</li></ul>

If you take XARELTO<sup>®</sup> for:

<ul><li><strong>Atrial Fibrillation:</strong> Take XARELTO<sup>®</sup> 1 time a day with your evening meal. If you miss a dose of XARELTO<sup>®</sup>, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.</li><li><strong>Blood clots in the veins of your legs or lungs:</strong><ul><li>Take XARELTO<sup>®</sup> once or twice a day as prescribed by your doctor.</li><li>Take XARELTO<sup>®</sup> with food at the same time each day.</li><li>If you miss a dose of XARELTO<sup>®</sup>:<ul><li><strong>and take XARELTO</strong><sup>®</sup> <strong>2 times a day:</strong> Take XARELTO<sup>®</sup> as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time.</li><li><strong>and take XARELTO<sup>®</sup> 1 time a day:</strong> Take XARELTO<sup>®</sup> as soon as you remember on the same day. Take your next dose at your regularly scheduled time.</li></ul></li></ul></li><li><strong>Hip or knee replacement surgery:</strong> Take XARELTO<sup>®</sup> 1 time a day with or without food. If you miss a dose of XARELTO<sup>®</sup>, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.</li></ul><ul><li>If you have difficulty swallowing the tablet whole, talk to your doctor about other ways to take XARELTO<sup>®</sup>.</li><li>Your doctor will decide how long you should take XARELTO<strong><sup>®</sup>.</strong> Do not stop taking XARELTO<strong><sup>®</sup></strong> without talking to your doctor first.</li><li>Your doctor may stop XARELTO<sup>®</sup> for a short time before any surgery, medical or dental procedure. Your doctor will tell you when to start taking XARELTO<sup>®</sup> again after your surgery or procedure.</li><li>Do not run out of XARELTO<sup>®</sup>. Refill your prescription for XARELTO<sup>®</sup> before you run out. When leaving the hospital following a hip or knee replacement, be sure that you have XARELTO<sup>®</sup> available to avoid missing any doses.</li><li>If you take too much XARELTO<sup>®</sup>, go to the nearest hospital emergency room or call your doctor right away.</li></ul>


<strong><em>Please see “What is the most important information I should know about XARELTO<sup>®</sup>?”</em></strong>

Tell your doctor if you have any side effect that bothers you or that does not go away.

<strong>Call your doctor for medical advice about side effects.</strong> <strong>You are also encouraged to report side effects to the FDA: visit <a href=”http://www.fda.gov/medwatch” target=”_blank” rel=”nofollow”>http://www.fda.gov/medwatch</a></strong> <strong>or call

1-800-FDA-1088.</strong> You may also report side effects to Janssen Pharmaceuticals, Inc., at

1-800-JANSSEN (1-800-526-7736).

<strong>Please</strong> <a href=”https://www.xareltohcp.com/shared/product/xarelto/prescribing-information.pdf” target=”_blank” rel=”nofollow”><strong>click here</strong></a> <strong>for full Prescribing Information, including Boxed Warnings, and Medication Guide.</strong>

Trademarks are those of their respective owners.


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