Ask a doctor on the topic of Internal medicine

Feeling of weakness Thrombosis Embolism still possible despite Xarelto

August 8, 2019 | 30,00 EUR | answered by Dr. med. Ive Dr. Schaaf

I was diagnosed with a thrombosis in my left arm (subclavian vein) three months ago. It was also determined that I had previously had two older thromboses (axillary vein and cephalic vein). The D Dimer value at the time of discovering the thrombosis was 1.91.

Since childhood, I have been diagnosed with Factor V Leiden (APC resistance) with a value of 1.7, but it has never been really taken seriously.

Since the thrombosis three months ago, I have been regularly taking the medication Xarelto (currently 20mg).

Since Sunday, I have not been feeling too well. I have been feeling weak on and off, especially in my legs. I can't really describe this feeling of weakness, I just feel weaker than "normal".

For example, this morning I went for a walk and did some back exercises. I didn't have any significant problems. In the afternoon, I was at a birthday party. I sat a lot, but I also walked around for short periods (10-15 min.) with inclines. Again, no problems.

However, when I was carrying boxes of leftover food and cake to the car at the end of the party (not really heavy boxes), I felt that weakness again. Since then, the pulling sensation in my arm and lower ribs (left side) has become stronger.

Now to my questions:

1. Should I be concerned that these feelings of weakness could be related to my thrombosis?

2. Is it possible to develop another thrombosis despite regular intake of Xarelto?
2a. If so, what could happen as a result, since I am already taking Xarelto?

3. Is it possible to develop a pulmonary embolism, even a "small" one, despite taking Xarelto?

It is probably more likely to be a back problem, but the feeling of weakness is making me somewhat uncertain. I am feeling somewhat anxious about all of this.

Dr. med. Ive Dr. Schaaf

Good evening,
since your arm thrombosis occurred only three months ago, the affected arm is not yet fully resilient - especially if the thrombosis has not significantly dissolved yet.
Most people underestimate the strain of a thrombosis. It is really hard work for the body to dissolve a thrombosis, and you should give your body time and the best possible support: compression!
Xarelto is highly effective in preventing embolisms, which can easily occur during the dissolution of the thrombus. However, not everyone tolerates Xarelto, and the symptoms you are experiencing now may have different causes, including Xarelto. Depending on how long you still need to take the anticoagulation treatment, it may be advisable to switch to a different medication.
Regarding your other questions:
2. - that is highly unlikely
2a. Probably nothing would be done, but it is also possible to switch to Heparin - that is a bit of a matter of belief.
3. Theoretically yes, but that is extremely unlikely.
Are all your questions answered?
If not, please feel free to ask.
Some answers can also be found on www.thrombose-hilfe.de.
Kind regards,
Dr. Schaaf