Suggestions for Peri-Procedural Management of Rivaroxaban

CrCl T 1/2

Time of last dose of rivaroxaban prior to procedure

(peri-procedural bridging is generally not required)

    Standard Risk of Bleeding

High Risk of Bleeding1

(major surgery, spinal puncture or placement of spinal/epidural catheter, and other situations in which complete hemostasis is required)

1 ASRA 4th edition 2018: hold 72 hours for all patients prior to neuraxial procedures, without regard for influence of renal function on half-life and clearance

> 80 ml/min         8.3 hrs       at least 24 hours at least 48 hours
50-79 ml/min 8.7 hrs   
30-49 ml/min 9 hrs
15-29 ml/min 9.5 hrs
< 15 ml/min unknown consider measuring drug activity with rivaroxaban assay to determine absence of drug effect