Popular rheumatoid arthritis, psoriatic arthritis, and ulcerative medication Xeljanz has been potentially linked to MACE injuries, strokes, and blood clots through a clinical study. These injuries require extensive treatment.
Read our Xeljanz Safety Evaluation Timeline for additional information on the approval history of Xeljanz and the study that has potentially connected the popular medication Xeljanz to strokes, blood clots, and MACE injuries such as heart attacks and cardiac arrests.
For additional information on the Xeljanz lawsuits, see our Xeljanz Area of Practice page.
Treatment for MACE Injuries
Major Adverse Cardiac Events (MACE) injuries include:
- Heart attack (myocardial infarction)
- Cardiac arrest
- Acute coronary syndrome
- Aortic dissection
Treatment for Heart Attacks
Treatment for a heart attack can include:
- Cardiac catheterization
- Stent placement
- Heart bypass surgery
- Heart valve surgery
- Pacemaker placement
- Heart transplant
Cardiac catheterization involves a probe being inserted into the blood vessel through a soft flexible tube known as a catheter. This allows the doctor to find the plaque buildup. The doctor may also inject dye into arteries through the catheter and take an X-ray to see how the blood is flowing and determine if there are any blockages.
An angioplasty procedure opens up the blocked artery by using a balloon attached to a catheter or by removing a plaque buildup.
A stent is a wire mesh tube that is inserted into the artery to keep it open after an angioplasty procedure.
Heart Bypass Surgery
In a heart bypass surgery, a doctor will reroute your blood flow around the blockage to restore heart function.
Heart Valve Surgery
During heart valve surgery, leaky valves are replaced to aid the heart in pumping blood.
A pacemaker is implanted beneath the skin and is designed to help the heart maintain a normal rhythm.
A heart transplant may be performed in severe cases when the heart attack has caused permanent tissue death to the majority of the heart.
Treatment for Cardiac Arrest
Emergency treatment for sudden cardiac arrest includes cardiopulmonary resuscitation (CPR) using a defibrillator or chest compressions to maintain blood flow which provides oxygen to the body. Using a defibrillator will deliver an electrical shock to the heart which momentarily stops the heart and often facilitates the return of the normal heart rhythm.
Long-term treatment for cardiac arrest can include medications such as antiarrhythmic drugs known as beta blockers or angiotensin-converting enzyme (ACE) inhibitors and channel blockers intended to reduce the risk of cardiac arrest.
A doctor may also insert an implantable cardioverter-defibrillator (ICD) which is a battery-powered unit placed into the body near the left collarbone. There are one or more electrode-tipped wires from the unit that run through veins to the heart to constantly monitor its rhythm. If the rhythm becomes too slow, the unit paces your heart as a pacemaker would. If it detects a dangerous rhythm change, it sends out a low or high energy shock to reset the heart to a normal rhythm.
A coronary angioplasty procedure can open the blocked coronary arteries which allows blood to flow more freely to the heart. The procedure is intended to reduce risk of serious arrhythmia. It involves a thin tube being passed through an artery (usually in the leg) all the way to the blocked artery in the heart. A catheter equipped with a special balloon tip briefly inflates to open the blocked artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long-term to restore blood flow to the heart. This procedure can be done at the same time as coronary catheterization.
Cardiac bypass surgery is a procedure that involves coronary artery bypass grafting. This means that veins or arteries are sewed away from the blocked or narrowed heart artery which restores blood flow to the heart and reduces the frequency of racing heartbeats.
Radiofrequency catheter ablation is also an option which is used to block a single abnormal electrical pathway. One or more catheters is moved through the blood vessels to the heart and is positioned along the electrical pathways that are causing the abnormal heart rate. The electrodes on the catheter tips are heated with radiofrequency energy to heat the tissue at the site of the arrhythmia in order to destroy it.
Corrective heart surgery is also an alternative if a patient has a congenital heart deformity, a faulty heart valve, or diseased muscle tissue due to cardiomyopathy. The surgery to correct the abnormality can improve heart rate and blood flow which reduces risk of abnormal heart rates.
Treatment for Acute Coronary Syndrome
Treatment usually involves medications and an angioplasty procedure. The procedure involves doctors inflating a small balloon attached to a catheter to open the blocked artery. A stent (wire mesh tube) may be permanently placed in the formerly blocked artery to keep it open. A coronary bypass surgery may also be used to reroute the blood flow. The surgeon takes a piece of blood vessel (graft) from another part of the body to create a new route for the blood to flow around the blocked artery.
Medications are also used to dissolve blood clots. These medications include thrombolytics (clot busters) which dissolve a blood clot by temporarily widening blood vessels, antiplatelet drugs to prevent future blood clots from forming, beta blockers to relax the heart muscle and slow the heart rate, angiotensin-converting enzyme (ACE) inhibitors to widen blood vessels and improve blood flow, and angiotensin receptor blockers (ARBs) to help control blood pressure.
Treatment for Aortic Dissection
Aortic dissection can be treated by medication, surgery, and other endovascular treatments. Depending on how much of the aorta is torn, repair may require open heart surgery which involves replacing the aorta with a fabric tube called a graft. Surgeons can also use stent grafts (fabric tube supported by metal wire stents) to repair the existing aorta. Stent grafts are placed into the patient endovascularly which means they are placed over a wire through a small incision in the groin, delivered upstream into the aorta, and then release stents like a spring. There are also hybrid procedures that combine open heart surgery with endovascular stent grafting techniques. Additionally, medications such as beta blockers are prescribed to lower a patient’s heart rate and blood pressure.
For Type A aortic dissection, surgeons remove as much of the dissected aorta as possible, block the blood from entering the aortic wall, and then reconstruct the aorta with a graft. Leaking aortic valves can also be replaced at this time.
For Type B aortic dissection, surgeons use similar techniques to those used to treat Type A, but they may also involve stents to act as scaffolding in the aorta to hold up the repairs.
After all types of aortic dissection treatments, patients will likely need to take medications to lower their blood pressure for the remainder of their lives.
For more information about MACE injuries connected to Xeljanz, read our Xeljanz Injuries: Major Adverse Cardiac Events blog.
Treatment for Strokes
Treatment for ischemic strokes focuses on restoring blood flow to the brain. It usually begins with taking drugs to break down blood clots and prevent others from forming. Medical professionals may administer blood thinners such as aspirin or inject a tissue plasminogen activator (TPA). An emergency procedure may include administering a TPA directly into an artery in the brain or using a catheter to physically remove the blood clot.
Other procedures include a carotid endarterectomy which involves opening the carotid artery and removing the plaque that could break off and travel to the brain. Another procedure is an angioplasty in which a surgeon inflates a small balloon inside the narrowed artery using a catheter. Then a mesh tube (stent) is inserted into the opening to prevent the artery from narrowing again.
Treatment for a hemorrhagic stroke involves controlling the bleeding and reducing pressure on the brain. It usually starts with taking medication to reduce the pressure and control the overall blood pressure. The treatment is also aimed at preventing seizures and any sudden constrictions of blood vessels.
If a patient is taking blood-thinning medications such as anticoagulants or antiplatelets, they can receive medications to counter the effects of the blood thinners to decrease the bleeding.
Otherwise, surgeons can repair the bulge in the blood vessel that burst (aneurysm) by placing small clamps at the base of the aneurysm or fill it with detachable coils to stop the blood flow and shrink the aneurysm.
If a patient has had an ischemic stroke or a TIA, the doctor may recommend preventative medications such as antiplatelet and anticoagulant drugs. Antiplatelet drugs make the platelet cells in the blood less sticky and less likely to clot. The most common antiplatelet drug is aspirin. Anticoagulant medications are given to reduce blood clotting.
Rehabilitation treatment for strokes includes speech therapy, physical therapy, occupational therapy, support groups, and psychological treatment. Speech therapy helps patients with difficulties speaking or understanding speech by practicing, relaxing the patient, and changing their communication style to make the process easier. Physical therapy helps a person relearn movements and coordination in addition to staying active. Occupational therapy helps patients carry out daily activities such as bathing, cooking, dressing, eating, reading, and writing. Support groups and psychological treatment help patients deal with the mental health issues that can occur after a stroke–such as depression–through counseling and/or antidepressant medications.
Treatment for Blood Clots
Treatment for blood clots range from medication to surgery. Medications can include blood thinning medications such as anticoagulants. These medications stop the blood clots from growing and allow the body to break down the blood clots naturally.
Surgical procedures to remove blood clots include catheter-directed thrombolysis procedures. These procedures involve a specialist directing a long tube (a catheter) to the blood clot. The catheter delivers the medication directly to the blood clot to help it dissolve. In thrombectomy surgeries, doctors use special instruments to carefully remove the blood clot and may insert a stent to keep the blood vessel, artery, or vein open. If a patient is unable to take blood thinners, a filter may be put into the inferior vena cava (the body’s largest vein) to catch blood clots before they can travel to internal organs.
Compression stockings are also used as treatment. The tight-fitting socks apply pressure to help reduce leg swelling and prevent more blood clots from forming.
Treatment depends on where the clot formed in the body, how much damage the blood clot could cause, and how dangerous it would be to remove the blood clot.
The goal in treating blood clots (especially those formed with DVTs) is to prevent blood clots from getting larger or breaking loose. Effective treatment can reduce an individual’s chances of developing more blood clots in the future.
For more information about increased risk of blood clots and strokes connected to Xeljanz, read our Xeljanz Stroke and Blood Clot Injuries blog.
How GoldenbergLaw Can Help
If you or a loved one have been injured after taking Xeljanz, contact the Dangerous Drug Attorneys at GoldenbergLaw. Our team has over thirty years of experience providing the Gold standard of advocacy. Leave the sleepless nights to us!