Preexisting anticoagulation with rivaroxaban

Rivaroxaban (Xarelto) is an oral direct inhibitor of factor Xa.
There are no specific antidotes against rivaroxaban. A possible antidote (andexanet alfa) for Factor Xa-inhibitors is currently under investigation.
Elimination half-life of rivaroxaban is 11–13 hours in older adults.

Surgery should be delayed for 24 hours after administration of the last dose. Bridging anticoagulation is not necessary. Neuraxial blockade is possible 22–26 hours after the last dose.

Consider giving rFVIIIa (NovoSeven) or aPCC (Beriplex) in case of acute bleeding.

Resume rivaroxaban 24–48 hours postoperatively or switch to standard thromboprophylaxis with LMWH 12–24 hours postoperatively depending on the individual postoperative bleeding risk or risk for thromboembolic complications.

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