PATIENT JOURNAL. XARELTO CarePath. Total Hip Replacement. Useful information for before, during and after surgery

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1 XARELTO CarePath Total Hip Replacement PATIENT JOURNAL Useful information for before, during and after surgery Always consult your healthcare professional. Please read additional Important Safety Information for XARELTO on the following pages. Please see full Prescribing Information, including Boxed Warnings, and Medication Guide at

2 Total Hip Replacement PATIENT JOURNAL Date of Surgery Orthopedic Surgeon Phone Number Primary Care Physician Phone Number Pharmacy Phone Number Emergency Contact The Hip Replacement Patient Journal was designed to be a useful tool to help you prepare for your surgery. The journal was designed to be carried with you to your appointments and provides: A helpful timeline Checklists A place to keep notes from your doctor visits For more information regarding your total hip replacement please visit: This Web site offers helpful information on what to expect before, during and after surgery. 1

3 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 4-6 WEEKS BEFORE YOUR SURGERY Meeting Your Orthopedic Surgeon Ask the following questions when you meet with your surgeon: 1. Why do you recommend total hip replacement surgery? 2. Are alternative treatments available? 3. What type of hip replacement surgery is best for me cemented or non-cemented? 4. What is the artificial hip joint made of metal, plastic, or ceramic? 5. Will I need to receive blood transfusions? If yes, should I give some of my blood now for during or after surgery? What if I don t, or can t, give blood? 6. What type of anesthesia do you recommend for me? 7. What are the risks and complications of surgery? 8. What will you recommend to treat my pain and to prevent blood clots after surgery? 9. How long will the artificial hip last? 10. Do I need medical permission or clearance for surgery? 2

4 4 weeks 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 4 WEEKS BEFORE YOUR SURGERY To Do List Take care of any needed dental work, including routine cleaning before your surgery. This will prevent germs in your mouth from entering the bloodstream and infecting the new joint. If your surgeon has asked you to obtain medical clearance, schedule an appointment for a preoperative history and physical examination with your primary care physician. If you work, ask your employer if you can get paid time off. Find out if you are eligible for short-term State Disability Insurance (SDI). NOTES 3

5 2 weeks 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 2 WEEKS BEFORE YOUR SURGERY Documenting Your Health History Keep your health history and records up to date to ensure safe, high-quality care for your hip replacement. Bring the following information to your appointments before your surgery: Medicines and supplements you take, including their dosage and frequency. Major illnesses or chronic conditions you have suffered from. Surgeries you have had and any related complications such as reactions to anesthesia. Allergies and sensitivities you have to food or medications. Your family history of diabetes, cancer, or heart disease. Your lifestyle habits including smoking, alcohol intake, exercise, and special diet. _ 4

6 2 weeks 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks Meeting with Your Surgeon Your orthopedic surgeon will meet with you before your surgery to discuss your medical history and to run some basic tests to evaluate your general health. This may include having you get an electrocardiogram to evaluate the condition of your heart and taking some samples of your blood and urine for routine laboratory tests. Plan to: Learn about hip replacement surgery from your surgeon s office, a community health education class, or other sources. Contact your health insurance company to confirm insurance authorization for your procedure, medications, and after-care arrangements you may need. Quit smoking. This will reduce your risk of postoperative complications. Ask your doctor about donating blood before your surgery. Refrain from medical procedures that are not absolutely necessary. Tell your surgeon immediately if you have any cuts or breaks in your skin. Ask your surgeon s office how to apply for a temporary Disabled Parking placard. The Department of Motor Vehicles or an auto club can provide this placard. NOTES 5

7 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 1-2 WEEKS BEFORE YOUR SURGERY How do I Prepare for my Recovery? Consider the following physical limitations when planning for your recovery: Your energy level may be lower than usual for 4-6 months after your surgery. You should not drive until you are told you can, typically for 4-6 weeks. Walking with an aid such as a wheeled walker makes it harder to get around or to move or carry things. Plan to: Ask a family member or friend to take you to and from the hospital. Fill all your prescriptions in advance. Arrange for someone to help make your meals and do light housekeeping for about 2 weeks. Ask someone to stand by while you bathe and get dressed for about 2 weeks. Stock up on toiletries and food. Prepare and freeze or purchase frozen nutritious meals in advance. Because stairs might be challenging during this time, consider putting your bed on the entry level of your home. Consider the following safety concerns: You will not be allowed to bend forward or to stoop after your hip surgery. Avoid sitting on low seats or beds as they are the easiest way to dislocate your hip following surgery. A walking aid is recommended for 4-6 weeks. Be cautious about strong pain relievers: they can make you sluggish or dizzy, increasing your risk of falling. Plan to: Keep items that you use often at waist level or slightly above. Have firm, comfortable seating that is higher than hip level readily available. Chairs with arm support are highly recommended. Adjust your bed height to hip level or higher. 6

8 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks How do I prepare for my recovery? continued Make sure the toilet seat is not below hip level. Remove slippery rugs and mats. Clear a wide path for easy maneuvering throughout your home. Unplug and remove electrical cords from walkways. What Equipment Can I Buy in Advance to Help my Recovery? Highly recommended (ask your doctor): Front-wheeled folding walker Raised toilet seat (if your toilet is low) Reacher Handheld shower head Optional: Long-handled sponge for bathing Sock aid Long-handled shoe horn Shower bench with adjustable legs Bathroom safety grip bar The Night Before You Go Into the Hospital Maintaining a positive attitude improves your chances of a successful outcome! Do not eat or drink anything after midnight. Take medications only as directed by your doctor. Leave all jewelry at home. Do not bring valuables to the hospital. Avoid alcoholic beverages. Do not wear contacts lenses wear glasses if you need them. 7

9 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks THE DAY OF YOUR SURGERY What Should I Bring to the Hospital? Must haves: Loose-fitting clothes such as a jogging suit or loungewear (worn to and from the hospital) Sturdy slip-on shoes with a closed back Personal grooming items including toothbrush, toothpaste, hairbrush, and lip moisturizer Your medical/pharmacy insurance card and method of payment for prescriptions (preferably a credit card) Hearing aids Consider these optional items: If you are sensitive to soaps or lotions, consider bringing your own shampoo and conditioner Cell phone Loose change for newspapers Magazines or other reading material Music device with an earpiece Note paper and pen An inspiring photograph or message Personal lightweight robe NOTES 8

10 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 1 week 1-3 DAYS AFTER YOUR SURGERY Recovery Team Your recovery is a team effort involving you, your friends and family, your surgeon, and the hospital staff. Your inpatient case manager or social worker will: Discuss options for home care and insurance coverage after you leave the hospital. Arrange home care needs as directed by the surgeon. Make sure you have transportation to get home from the hospital. Help you get home equipment as needed and coordinate related insurance benefits. Your inpatient physical therapist will: Show you how to avoid dislocating your hip. Explain what you must do before leaving the hospital. Help you choose the safest walking aid based your performance and safety. Review exercises and a home program for you to do after your operation. NOTES 9

11 1 week 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks THE DAY YOU LEAVE THE HOSPITAL After Your Operation It is important to discuss with your healthcare team: 1. Your appropriate activity level 2. How long to use a walking aid 3. The amount of weight your new hip can support 4. Your recommended rest period 5. How to care for your incision 6. Return appointments 7. When to schedule any recommended preventive dental treatment 8. Recommended blood clot prevention 9. Recommended prescription or over-the-counter products for pain medication 10. How long to observe dislocation precautions: Avoid twisting or pivoting on the leg that was operated on Do not cross your legs at knees or ankles Avoid bending your hip more than 90 o 10

12 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week 1 week 2 weeks 3 weeks 4 weeks 5 weeks 6 weeks 2-6 WEEKS AFTER YOUR SURGERY Living with Your New Hip Alert your surgeon s office of the following: Drainage from incision Increasing redness or pain around incision Increased swelling to hip despite rest and elevation Pain that is not relieved by pain medication and rest New calf or thigh pain in either leg Temperature of 101 o F or higher Low-grade fever (less than 101 o F) lasting several days Increased weakness or fatigue Persistent nausea or vomiting Persistent itching or rash Any break in your skin Things to keep in mind past 6 weeks: Avoid routine dental work for 3 months. Follow your doctor s or dentist s instructions for taking a prescribed antibiotic before you have dental work. Follow-up with your surgeon as directed for routine evaluation and x-rays. High-impact activities can cause early loosening of your hip joint. Metal detectors might be activated by your new implant; alert appropriate security staff of your hip implant. 11

13 WHAT IS XARELTO (rivaroxaban)? XARELTO is a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had knee or hip replacement surgery. Important Safety Information WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT XARELTO? For people taking XARELTO for atrial fibrillation: People with atrial fibrillation (an irregular heart beat) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. XARELTO lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO, you may have increased risk of forming a clot in your blood. Do not stop taking XARELTO without talking to the doctor who prescribes it for you. Stopping XARELTO increases your risk of having a stroke. If you have to stop taking XARELTO, your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming. XARELTO can cause bleeding, which can be serious, and rarely may lead to death. This is because XARELTO is a blood thinner medicine that reduces blood clotting. While you take XARELTO you are likely to bruise more easily and it may take longer for bleeding to stop. You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding, including: Aspirin or aspirin-containing products Non-steroidal anti-inflammatory drugs (NSAIDs) Warfarin sodium (Coumadin, Jantoven ) Any medicine that contains heparin Clopidogrel (Plavix ) Other medicines to prevent or treat blood clots Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above. Call your doctor or get medical help right away if you develop any of these signs or symptoms of bleeding: Unexpected bleeding or bleeding that lasts a long time, such as: Nosebleeds that happen often Unusual bleeding from gums Menstrual bleeding that is heavier than normal, or vaginal bleeding Bleeding that is severe or that you cannot control Red, pink, or brown urine Bright red or black stools (looks like tar) Cough up blood or blood clots Vomit blood or your vomit looks like coffee grounds Headaches, feeling dizzy or weak Pain, swelling, or new drainage at wound sites Spinal or epidural blood clots (hematoma): People who take a blood thinner medicine (anticoagulant) like XARELTO, and have medicine injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). continued on next page 12

14 Important Safety Information (cont.) Your risk of developing a spinal or epidural blood clot is higher if: A thin tube called an epidural catheter is placed in your back to give you certain medicine You take NSAIDs or a medicine to prevent blood from clotting You have a history of difficult or repeated epidural or spinal punctures You have a history of problems with your spine or have had surgery on your spine If you take XARELTO (rivaroxaban) and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots. Tell your doctor right away if you have back pain, tingling, numbness, muscle weakness (especially in your legs and feet), or loss of control of the bowels or bladder (incontinence). XARELTO is not for patients with artificial heart valves. WHO SHOULD NOT TAKE XARELTO? Do not take XARELTO if you: Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO if you currently have unusual bleeding. Are allergic to rivaroxaban or any of the ingredients of XARELTO. WHAT SHOULD I TELL MY DOCTOR BEFORE OR WHILE TAKING XARELTO? Before taking XARELTO, tell your doctor if you: Have ever had bleeding problems Have liver or kidney problems Have any other medical condition Are pregnant or plan to become pregnant. It is not known if XARELTO will harm your unborn baby. Tell your doctor right away if you become pregnant while taking XARELTO. If you take XARELTO during pregnancy, tell your doctor right away if you have bleeding or symptoms of blood loss. Are breastfeeding or plan to breastfeed. It is not known if XARELTO passes into your breast milk. You and your doctor should decide if you will take XARELTO or breastfeed. Tell all of your doctors and dentists that you are taking XARELTO. They should talk to the doctor who prescribed XARELTO for you before you have any surgery, medical or dental procedure. Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Some of your other medicines may affect the way XARELTO works. Certain medicines may increase your risk of bleeding. See What is the most important information I should know about XARELTO? Especially tell your doctor if you take: Ketoconazole (Nizoral ) Itraconazole (Onmel, Sporanox ) Ritonavir (Norvir ) Lopinavir/ritonavir (Kaletra ) Indinavir (Crixivan ) Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol -XR, Teril, Epitol ) Phenytoin (Dilantin-125, Dilantin ) Phenobarbital (Solfoton ) Rifampin (Rifater, Rifamate, Rimactane, Rifadin ) St. John s wort (Hypericum perforatum) continued on next page 13

15 Important Safety Information (cont.) Ask your doctor if you are not sure if your medicine is one listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine. HOW SHOULD I TAKE XARELTO (rivaroxaban)? Take XARELTO exactly as prescribed by your doctor. Do not change your dose or stop taking XARELTO unless your doctor tells you to. Your doctor will tell you how much XARELTO to take and when to take it. Your doctor may change your dose if needed. If you take XARELTO for: Atrial Fibrillation: Take XARELTO 1 time a day with your evening meal. If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time. Blood clots in the veins of your legs or lungs: Take XARELTO once or twice a day as prescribed by your doctor. Take XARELTO with food at the same time each day. If you miss a dose of XARELTO : and take XARELTO 2 times a day: Take XARELTO as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time. and take XARELTO 1 time a day: Take XARELTO as soon as you remember on the same day. Take your next dose at your regularly scheduled time. Hip or knee replacement surgery: Take XARELTO 1 time a day with or without food. If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time. If you have difficulty swallowing the tablet whole, talk to your doctor about other ways to take XARELTO. Your doctor will decide how long you should take XARELTO. Do not stop taking XARELTO without talking to your doctor first. Your doctor may stop XARELTO for a short time before any surgery, medical or dental procedure. Your doctor will tell you when to start taking XARELTO again after your surgery or procedure. Do not run out of XARELTO. Refill your prescription for XARELTO before you run out. When leaving the hospital following a hip or knee replacement, be sure that you have XARELTO available to avoid missing any doses. If you take too much XARELTO, go to the nearest hospital emergency room or call your doctor right away WHAT ARE THE POSSIBLE SIDE EFFECTS OF XARELTO? Please see What is the most important information I should know about XARELTO? Tell your doctor if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You are also encouraged to report side effects to the FDA: visit or call FDA You may also report side effects to Janssen Pharmaceuticals, Inc., at JANSSEN ( ). Please read additional Important Safety Information for XARELTO on the following pages. Please see full Prescribing Information, including Boxed Warnings, and Medication Guide at Trademarks are those of their respective owners. 14

16 1-888-XARELTO XARELTO is licensed from Bayer HealthCare AG, Leverkusen, Germany. Janssen Pharmaceuticals, Inc March Janssen Pharmaceuticals, Inc.

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