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Dear Dr. Roach, My 32 year old son has been on Xarelto for about two months for deep vein thrombosis. I was with him when he banged his head hard against the door of his SUV two days ago. It has no symptoms, but I am still very worried. He is alone in a hotel room for the week at school. Should he pbad a scan to make sure he is fine? What should we do? Does he need to go to the emergency?
C. H.
Xarelto is a medicine that makes it more difficult to clot blood. It is administered to people with inappropriate blood clotting, such as deep vein thrombosis (clot) that your son had two months ago.
Ideally, the dose of medication would bring the body back to a perfect balance with no increased risk of clotting or bleeding. In practice, things may not work perfectly.
People can still have clots despite taking Xarelto, warfarin or other medications. More frequently, patients may have bleeding that may be mild or severe. Among the most dangerous forms of excessive bleeding is inside the head, where the place is very limited. Heavy bleeding in the head will compress the brain and, in some cases, cause a devastating stroke.
For this reason, even mild head trauma that would otherwise be transmitted as low risk is usually badessed with a CT scan. The vast majority of them will be negative. People of your son's age are less likely to bleed.
In studies, the risk of bleeding due to head trauma in people on anticoagulants ranged from 3% to 9%. Many of the participants in the studies were older (the average age was in their 70s) and had been seen in an emergency. Someone in your son's position presents a lower risk, especially after two weeks and especially without any symptoms.
Against this low risk is the fact that he is alone, where he might not be able to get help if he suddenly developed symptoms.
It is always difficult to judge very low risk and potentially catastrophic events. The disadvantage of a CT scan is a modest amount of radiation and a few hundred dollars (this is the price I quoted for people without insurance), although a visit to the emergency costs much more. Since I can not give precise medical advice, I suggest that your son talk to the person who prescribed Xarelto.
Dear Dr. Roach, I am an 81-year-old woman, and at the end of August, I will be a teaching badistant to first- and second-year students, some of whom may not be vaccinated. The MMR vaccine was not available when I was a child and I do not remember having these diseases. Is there a test to check my immunity? Should I get MMR or am I worried unnecessarily?
S. W.
More than 99% of people born before 1957 had measles, mumps and rubella, and neither booster vaccines nor blood tests to prove immunity are recommended because immunity after these diseases is considered permed.
The danger of having unvaccinated children at school is that they risk contracting one of these diseases. Measles, for example, can be contagious until four days before the disease can be diagnosed.
I strongly support the evidence of vaccination of school children from a public health point of view, with the sole exception of medical necessity. When there is more than two percent of immunization non-compliance, the disease can spread. This is what we are seeing in many parts of the United States, where many other areas are at risk.
Dr. Roach regretted that he could not reply to individual letters, but would incorporate them in the column whenever possible. Readers can e-mail their questions to [email protected]
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