[cindyl]

Blood thinner use with multiple myeloma

by cindyl on Sat Sep 27, 2014 1:05 pm

Hi, so my husband has been hospitalized with atrial fibrilation. He's doing well, converted to a regular rate and rhythm with medication. And now they are starting blood thinners.

Somewhere my brain keeps asking the question, is this a good idea with multiple myeloma? I understand the risk benefit thing and all that. Just makes me uneasy. Anyone have an answer for that?

[Cheryl G]

Re: Blood thinner use with multiple myeloma

by Cheryl G on Sat Sep 27, 2014 1:32 pm

Hi Cindy,

Glad to hear that your husband's doctors were able to convert his heart back to normal rhythm.

You probably know this, but blood thinners are used regularly in myeloma patients when they are being treated with certain drugs, primarily Revlimid and thalidomide when combined with dexamethasone. This articles discusses some recommendations that were drafted at one point about the use of blood thinners in such situations,

"Experts Draft Guidelines For The Prevention Of Blood Clots In Multiple Myeloma Patients (IMW 2011)," The Myeloma Beacon, June 1, 2011.

I'm not sure, though, if the recommendations were ever finally published in a medical journal.

I've not heard anything about it being bad to prescribe blood thinners to myeloma patients when they are not on treatment, if that's what you're concerned about.

Good luck to you and your husband.

[cindyl]

Re: Blood thinner use with multiple myeloma

by cindyl on Sat Sep 27, 2014 1:59 pm

Thanks Cheryl, I also found that article right after I posted my question. It's kind of one of those things you remember after you're reminded. We're hoping this is a nice, short hospital stay. Then I guess we can run the cardiac gauntlet once again.

[Jonah]

Re: Blood thinner use with multiple myeloma

by Jonah on Mon Sep 29, 2014 4:57 am

cindyl,

Sorry to hear about your husband's heart issue.

Did you post a while back that your husband also fractured his ribs? I found this posting,

"Fractured ribs from a fall - should restart Zometa now?", Beacon forum discussion started Aug 22, 2014.

but it's by "CindyLouise," so I'm not sure if that's the same as you.

In any case, if it is you and your husband has fractured ribs, I wonder if that raises any red flags for the use of blood thinners. It seems to me that fractured ribs could sometimes cause internal bleeding which, if someone is on blood thinners, might not be such a great idea.

Of course, getting a struck from abnormal heart rhythm is also not such a great thing. So I guess there are risks and benefits.

[Nancy Shamanna]

Re: Blood thinner use with multiple myeloma

by Nancy Shamanna on Mon Sep 29, 2014 9:18 am

Hi cindyl, I know that many myeloma patients take blood thinners, even at the low range of 81 mg of aspirin. After one has had a blood clot, it seems that at least for a few months,one would be put on an actual therapeutic blood thinner. And with atrial fibrillation, a patient is given medications to control the heart rate, and it seems from your post, blood thinners.

The question I would ask the two different specialists, the cardiologist and the haematological oncologist, would be about the intensity of the dosage. I don't know if the blood thinners come in differing doses, but it would be good to discuss this issue with both doctors, I would think. This is definitely a matter of multi-disciplinary medical care!

[Cheryl G]

Re: Blood thinner use with multiple myeloma

by Cheryl G on Mon Sep 29, 2014 3:04 pm

cindyl,

Would you mind saying which blood thinner your husband was put on? I'm curious if it's Xarelto (rivaroxaban), as I've noticed more and more people here in the forum mentioning that they've been put on it. I don't see Coumadin (warfarin) mentioned as often as it was in the past, which I find interesting.

Thanks, and I also hope things improve for your husband.

[Dr. Jason Valent]

Re: Blood thinner use with multiple myeloma

by Dr. Jason Valent on Mon Sep 29, 2014 4:46 pm

It's generally fine to use whatever blood thinner is recommended by cardiologists for atrial fibrillation.

[cindyl]

Re: Blood thinner use with multiple myeloma

by cindyl on Tue Sep 30, 2014 6:11 am

Thank you all for the responses. The blood thinner is Eliquis (apixaban). I know the reason for less usage of Coumadin is simply easier control. You don't have the constant need to check your INR. The reason they chose the Eliquis was because my husband has some kidney issues related to multiple myeloma, and Eliquis is supposed to be easy on the kidneys.

And Dr Valent, thank you for your input, as that was on the list of questions the hospitalist wanted me to clarify with the oncologist. His primary concern with Eliquis was simply the newness of blood thinners like Eliquis. Basically, while they are deemed safe, they haven't been in use long enough to have answers for how they affect the general population with multiple conditions.

On another note, we spent another 6 hours in the ER yesterday due to extreme low blood pressures. Of course, they were much better once we arrived in our overcrowded ER. But did bottom out a few times. Nothing noteworthy was found on any of his tests.

Unfortunately we've been down the nothing-is-wrong road before and it scares the hell out of me. Feels like we are setting up for another major event, and all we can do is wait for it to happen.

Thank you all for the help, it feels less lonely.

[wesley]

Re: Blood thinner use with multiple myeloma

by wesley on Sat Oct 04, 2014 7:49 pm

I have been on a blood thinner (Xarelto) since a blood clot in my ankle in July. I have had no difficulty with it, and will stay on it as long as I am on Revlimid maintenance.

Best of luck, Cindy.