# Foot injury - advice? {It’s a blood clot} **URL:** \ **Category:** In My Humble Opinion\ **Created:** [August 27, 2022, 8:08pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446 "2022-08-27T20:08:18Z")\ **Posts on this page:** 20\ **Page:** 11
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 9:40am UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/201 "2022-09-10T09:40:24Z")
Finally got a real room at 2am [![](https://i.imgur.com/R3dKpwI.jpg) ](https://i.imgur.com/R3dKpwI.jpg) ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [September 10, 2022, 9:54am UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/202 "2022-09-10T09:54:34Z")
Good for you! Hope you’re feeling better and they get your circulatory traffic restored to normal very soon. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 10, 2022, 12:22pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/203 "2022-09-10T12:22:09Z")
Oh good! I hope you can get some rest, now. And hey, the odds are excellent they will fix the clot in the calf when they fix the clot in the lungs, and your pain should improve soon, too. I hope you have access to good books while you wait. My recollection is that they basically treated my mom with IV anticoagulants, and it was more boring than anything else. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 3:01pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/204 "2022-09-10T15:01:34Z")
So they want to keep me on the Xarelto. One weird thing is the admitting doctor told me you have to take them with fatty foods(his example was toast with butter) or they don’t work well. Something neither the prescribing NP nor the pharmacist who I consulted with mentioned, except to take them w food (I chose saltines). Admitting doc thinks that’s why I got the PE. ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 3:07pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/205 "2022-09-10T15:07:10Z")
If you’re **extremely** bored, here’s the manufacturer’s data about food/no food with Xarelto. Spoiler alert: it seems like food \> no food, but that fats aren’t a real factor in the efficacy, biodynamics, and bioavailability. IANAD > **[Food Effects of XARELTO](https://www.janssenscience.com/products/xarelto/medical-content/food-effects-of-xarelto)** > > A summary of clinical data regarding the effect of food on XARELTO® (rivaroxaban) administration. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [September 10, 2022, 3:19pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/206 "2022-09-10T15:19:36Z")
I’m late to this ~~party~~ discussion, but holy shit! 😲 I’m so sorry you’re going through this and sincerely hope the situation is resolved soon and with no additional problems. I’ll follow this thread now with fingers crossed. On the upside, you are one very good-looking dude, even in your hospital gown. Damn! If only I were 25 years younger… ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 3:24pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/207 "2022-09-10T15:24:10Z")
> [@ThelmaLou](#): > > Damn! If only I were 25 years younger… Oh, I think we’d ALL be in trouble 😉 ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [September 10, 2022, 3:28pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/208 "2022-09-10T15:28:16Z")
You naughty boy. 👼🏽 ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 3:38pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/209 "2022-09-10T15:38:23Z")
> [@DavidNRockies](#): > > If you’re **extremely** bored, here’s the manufacturer’s data about food/no food with Xarelto. > > Spoiler alert: it seems like food \> no food, but that fats aren’t a real factor in the efficacy, biodynamics, and bioavailability. IANAD Huh. Definitely bringing up the fatty food thing with attending physician this morning (the _admitting_ doctor was the one brought up the fat thing). ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 3:45pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/210 "2022-09-10T15:45:14Z")
> [@ThelmaLou](#): > > On the upside, you are one very good-looking dude, even in your hospital gown. Thank you, for that and your sympathy. 🤗 > [@](#): > > Damn! If only I were 25 years younger… [I’m actually older than I look](https://boards.straightdope.com/t/happy-cake-day-to-me/963493/13), though my 40 year old lady friend might have words with you. 😁 ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 4:04pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/211 "2022-09-10T16:04:19Z")
Yet another country (UK) heard from: > **[Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken...](https://www.gov.uk/drug-safety-update/rivaroxaban-xarelto-reminder-that-15-mg-and-20-mg-tablets-should-be-taken-with-food)** > > MHRA has received a small number of reports suggesting lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban on an empty stomach; remind patients to take 15 mg or 20 mg rivaroxaban tablets with food. > Clinical trials of rivaroxaban showed that food intake does not affect absorption of 2.5 mg or 10 mg tablets, **while absorption of 20 mg tablets was optimal when taken with high-fat, high-calorie meal**. For this reason, rivaroxaban 15 mg and 20 mg tablets are to be taken with food. [bolding mine] So that’s one (more) data point … and with the 20mg (not 15mg) tabs. What does this all mean? Who knows. It seems very clear … that the data isn’t clear. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [September 10, 2022, 4:10pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/212 "2022-09-10T16:10:55Z")
Okay… if I were 14 years younger. 😉 Carry on and get well. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 4:33pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/213 "2022-09-10T16:33:06Z")
> [@DavidNRockies](#): > > So that’s one (more) data point … and with the 20mg (not 15mg) tabs. And I’m taking 2 15 mg tabs. So maybe fat helps at higher doses. ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 4:54pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/214 "2022-09-10T16:54:18Z")
My $0.02: Since the data isn’t compelling one way or the other – even to the extent of establishing a _clear_ positive impact of a fatty meal _in a dose-dependent_ manner (ie, the need for fat increases as the dose is increased) … - I would be hesitant, as a doctor, to take a strong stance on the ‘fat’ subject, and - My personal hypothesis is that there are probably no end of other individual factors (ie, particular to a given patient) that have a larger impact than the fat issue. Without very specific dose-dependent data, it’s not safe to presume that 2 x 15mg tablets will behave the same as a 20mg tablet. It might. It might not. There just doesn’t seem to be data to say with confidence. So … just get better 🙂 ---
**Author:** ![Tibby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tibby/32/17030_2.png) [@Tibby](https://boards.straightdope.com/u/Tibby)\ **Post date:** [September 10, 2022, 5:06pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/215 "2022-09-10T17:06:12Z")
For a more detailed explanation of food vs. oral anti-coagulant absorption: > **[The Clinical Significance of Drug–Food Interactions of Direct Oral...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395160/)** > > Cardiovascular diseases are the most common cause of death in the world. For almost 60 years, vitamin K antagonists (VKAs) were the mainstay of anticoagulation therapy, but in recent years direct oral anticoagulants (DOACs) have become the... _High-fat foods are known to reduce the overall concentration of betrixaban. In contrast, **rivaroxaban** (XARELTO®) 20 mg is better absorbed and has almost 100% bioavailability when taken with food._ On a more alarming note: why is Bob (Better Call Saul) Odenkirk in your hospital bed? ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 5:16pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/216 "2022-09-10T17:16:19Z")
> [@Tibby](#): > > _High-fat foods are known to reduce the overall concentration of betrixaban. In contrast, **rivaroxaban** (XARELTO®) 20 mg is better absorbed and has almost 100% bioavailability when taken with food._ If we’re all reading this the same way, I see: - A high-fat meal _reduces_ the bioavailability of _some other drug that isn’t Xarelto,_ and/but - Food – not necessarily fatty – increases the bioavailability of Xarelto Clear as mud 😉 ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [September 10, 2022, 5:21pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/217 "2022-09-10T17:21:22Z")
JFC … I can’t stop looking at that picture. He IS handsome. Sigh. 😉 ---
**Author:** ![Tibby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tibby/32/17030_2.png) [@Tibby](https://boards.straightdope.com/u/Tibby)\ **Post date:** [September 10, 2022, 5:31pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/218 "2022-09-10T17:31:41Z")
Fatty foods per se don’t appear to affect the bioavailability of rivaroxaban, but fiber/cellulose (carbohydrate) appears to _lower_ absorption. So, you’re less likely to ingest fiber with a fatty meal. An indirect benefit. _However, the results of an in vitro study by Raiola et al. showed that the presence of insoluble and soluble fiber as well as cellulose may cause a decrease in the bioavailability of dabigatran, rivaroxaban and apixaban._ ---
**Author:** ![superwombat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/superwombat/32/16616_2.png) [@superwombat](https://boards.straightdope.com/u/superwombat)\ **Post date:** [September 10, 2022, 5:42pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/219 "2022-09-10T17:42:25Z")
I had a double PE a couple years ago. Was experiencing shortness of breath, progressively worse over a couple of months, got to the point where walking up a 10-stair flight would wind me. Figured I’d get checked out, so went to a walk-in clinic, they checked for fluid in lungs, nothing. Checked SpO2, fine. (sitting in the waiting room allowed time for percentage to normalize) Recommended I go to ER and get scanned. Ok, sure. A few days later, it so happened I had to bring a child in my care to the ER to get pinkeye meds. Figured I’d mention my shortness of breath. Then things started happening. Got brought in, bloodwork done, SpO2 checked - not at acceptable levels. Bloodwork comes back, yep, need a scan. Arrange to have child picked up, this might be a while. Get CT scan with contrast, yep, double PE. Get admitted, 3 days stay in fancy bed with the machine that goes “ping,” on IV thinners until SpO2 stays at acceptable levels. Unknown origin for the clot, as such, am now on 5mg Apixaban twice a day until forever. Lung clinic a year later, do stress tests, lung fitness tests, all seem good, but not 100%. Prescribed Arnuity Ellipta daily inhaler and salbutamol for if any sudden attacks. Ultrasound shows excellent encapsulation of clots. Today I feel I’m at about 95% of what I was before. Just a Canadian anecdatum for those interested. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [September 10, 2022, 8:12pm UTC](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446/220 "2022-09-10T20:12:07Z")
Wow, that’s a tough sequence of events, @superwombat . And at variance with my short experience - my O2 levels never fell below 95%, so this is all a bit perfunctory, just being careful. Glad you followed up but sorry it’s an ongoing and \*chronic problem, that sucks and you have my sympathies. \*somewhat chronic? not sure I followed all of the chronology, doesn’t encapsulation of the clots mean they resolved? [Previous page](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446.md?page=10) [Next page](https://boards.straightdope.com/t/foot-injury-advice-it-s-a-blood-clot/970446.md?page=12)