Dr. Keith Roach

DEAR DR. ROACH: I am an 81-year-old female who has been on Xarelto for years due to my deep vein thrombosis (DVT). I also have an inferior vena cava (IVC) filter. I read that low-dose aspirin (325 mg) is just as effective in preventing clots in the legs as Xarelto, which is very expensive. My doctor advises against changing to aspirin, but won’t give me an explanation as to why.
I switched anyway, and the redness in my foot disappeared. After one month of taking 325 mg of coated aspirin daily, I have no symptoms and actually feel better. What are your thoughts? — A.B.
ANSWER: Although aspirin is better than nothing, it has been proven in multiple trials to be less effective than Xarelto and similar medicines in people who are at risk for blood clots. In a yearlong trial comparing the two, recurrences of DVT (a blood clot in the deep veins of the leg) occurred in just over 1% of people taking Xarelto and in 4.4% of people taking aspirin. (This study used low-dose aspirin — 100 mg — rather than the full-dose of 325 mg that you are taking.) The risk of bleeding was about the same among the aspirin group and the Xarelto group.
Aspirin is an anti-inflammatory, which may be why the redness in your foot disappeared. I doubt it had anything to do with a blood clot.
For people at a high risk, I recommend against changing from a more effective medicine like Xarelto to aspirin. In your case, you are protected against a blood clot in the lung by your filter, which is designed to catch any clot before it can get to the lung. Unfortunately, the IVC filter slightly increases the risk of a recurrence of a blood clot in the legs, so it’s important to keep taking medication to reduce your risk.
Given the serious nature of a blood clot, I can’t recommend disregarding your doctor’s advice, although you deserve a thorough explanation from your doctor. If the main issue for your wanting to change medications is the expense, you might ask your doctor if there are less-expensive alternatives that would still be as effective as Xarelto. The manufacturer also offers a program to help with expenses.
DEAR DR. ROACH: I am a 67-year-old woman in good health. I have been taking omeprazole for at least 10 years, and it was originally prescribed to help chronic cough. With all the talk of an increased dementia risk from this medication, what is the safest way to wean off of it? — C.H.
ANSWER: There is some evidence that proton-pump inhibitors like omeprazole increase dementia risk. But the evidence isn’t strong, and there are studies that haven’t shown a risk. Still, omeprazole and similar drugs do have the potential for long-term side effects, and it is always worth a periodic trial off of the medicine to see whether it is still needed.
If you and your physician agree to stopping the medication, my usual recommendation is to cut the dose in half for a week, then take it every other day for another week before stopping. People on a high dose may need to cut the dose in half twice.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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