Dear Dr. Roach: My 32-year-old son is on Xarelto for a deep vein thrombosis for about two months now. I was with him when he hit his head hard on the door hatch of his SUV two days ago. He has no symptoms, but I am still concerned. He is in a hotel for the week by himself for school. Should he have a scan to make sure he is OK? Does he need to visit the emergency room? CH
Answer: Xarelto is a medication that makes it harder for the blood to clot. It is given to people with inappropriate blood clotting, such as the deep vein thrombosis (clot) your son had two months ago. Ideally, the dose of the medication would bring the body back to perfect balance, with no increased risk of clotting or bleeding. In practice, things may not work perfectly. People can still get clots despite taking Xarelto, warfarin or other drugs. More frequently, people can have bleeding episodes, which can be mild or severe. Among the most dangerous forms of excess bleeding is inside the head, where there is very limited room. A lot of bleeding inside the head will compress the brain, and in some cases can lead to a devastating stroke.
For this reason, even mild head trauma that would otherwise be passed as low risk is usually evaluated with a CT scan. The vast majority will be negative. People your sons age are less likely to have bleeding.