TREATMENT CONSIDERATIONS WHILE TAKING XARELTO®
Switching to or from XARELTO®
FROM WARFARIN
Stop warfarin and start XARELTO® when INR is <3.0
FROM UNFRACTIONATED HEPARIN
Stop the infusion and start XARELTO® at the same time
FROM OTHER ANTICOAGULANTS
Start XARELTO® 0 to 2 hours prior to the next scheduled evening administration of the other anticoagulant
TO WARFARIN*
One approach is to stop XARELTO® and start parenteral anticoagulant and warfarin at time of next scheduled XARELTO® dose
TO OTHER ANTICOAGULANTS†
Stop XARELTO® and start other anticoagulant when the next dose of XARELTO® would have been given
◇For VTE prophylaxis in acutely ill medical patients at risk for thromboembolic complications who are not at high risk of bleeding.
*No clinical trial data are available to guide converting patients from XARELTO® to warfarin. XARELTO® affects INR, so INR measurements made during coadministration with warfarin may not be useful for determining the appropriate dose of warfarin.
†Oral or parenteral rapid-onset anticoagulants.
BLEED MANAGEMENT CONSIDERATIONS IN PATIENTS TAKING XARELTO®
- Promptly evaluate any signs and symptoms of blood loss and consider the need for blood replacement
- Discontinue XARELTO® in patients with active pathological hemorrhage
- An agent to reverse the anti-factor Xa activity of rivaroxaban is available
- Partial reversal of prothrombin time prolongation has been seen after administration of PCCs in healthy volunteers
- The use of other procoagulant reversal agents like aPCC or rFVIIa has not been evaluated
This is not intended to replace clinical judgment or determine individual patient care.
Temporary discontinuation for surgery and other procedures
If XARELTO® must be discontinued for a procedure, follow these guidelines:
Before procedure:
- Stop XARELTO® at least 24 hours before the procedure
- In deciding whether a procedure should be delayed until 24 hours after the last dose of XARELTO®, the increased risk of bleeding should be weighed against the urgency of intervention

After procedure:
- Restart XARELTO® as soon as adequate hemostasis is established
- If oral medication cannot be taken during or after surgical procedures, consider a parenteral anticoagulant
Note that the half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.
Note that the half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.
Other administration options

aPCC = activated prothrombin complex concentrate; DOAC = direct oral anticoagulant; INR = international normalized ratio; NG = nasogastric; PCC = prothrombin complex concentrate; rFVIIa = recombinant factor VII.