Mets Day 993: New NIH schedule

Yesterday afternoon I received an email from Dr. Agarwal's patient care coordinator with a revised schedule for my NIH appointments. Instead of going in next Monday, I will go in on Thursday, January 8, for blood work, the CT urogram, and the regular CT scan that had been scheduled for January 20. I'll also have an EKG and meet with the anesthesiologist to prep for the cystography that will take place on the 20th.

The NIH coordinator also noted that I should seek confirmation from Dr. Aragon-Ching to discontinue taking Xarelto on January 10, 10 days before the surgery. I forwarded that request to her, and she responded:

I often advise to only stop Xarelto for about 2-3 days prior to a procedure.  While a longer interval may be desired for a higher bleeding risk procedure, the concern for thrombosis (new clots) that develops in patients with cancer undergoing surgery is equally a concern as well.  If this is possible and would not unduly compromise Dr. Agarwal's ability to properly (and safely) evaluate you, then it's preferable.  If not, then go with the plans as outlined (I'm cc'ing Dr. Agarwal here as well).  Xarelto can also be resumed postoperatively when hemostasis has been achieved, perhaps 24 - 48 hours after (depending on how the bleeding was peri-operatively and your ability to take in pills orally), at the same dose of 20 mg thereafter daily.  Intravenous heparin would be an alternative if oral administration becomes a problem for whatever reason.

It's an interesting tension, between stopping the drug to avoid bleeding problems, and continuing the drug to reduce the risk of pulmonary embolisms.

Happy new year!