For US Healthcare Professionals

Important Safety Information

US Prescribing Information

Switching to or from XARELTO®

Switching adult patients to XARELTO®

From warfarin

  • Stop warfarin
  • Start XARELTO® when INR is <3.0 

From unfractionated heparin

  • Stop the infusion
  • 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 (eg, LMWH)
  • Omit administration of the other anticoagulant

Switching adult patients from XARELTO®

To warfarin (one approach)†

  • Stop XARELTO®
  • Start parenteral anticoagulant and warfarin at time of next scheduled XARELTO® dose

To other anticoagulants

  • Stop XARELTO®
  • Start other anticoagulant when next dose of XARELTO® would have been given

*Oral or parenteral rapid-onset anticoagulants.

†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.

INR = international normalized ratio; LMWH = low-molecular-weight heparin.

Bleed management considerations*

Blood management icon
  • 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 XARELTO® is available
  • Use of procoagulant reversal agents—such as PCC, activated prothrombin complex concentrate, or rFVIIa—may be considered but has not been evaluated in clinical efficacy and safety studies
  • Monitoring for the anticoagulation effect of XARELTO® using a clotting test (PT, INR, or aPTT) or anti-factor Xa activity is not recommended

*This is not intended to replace clinical judgment or determine individual patient care.

aPTT = activated partial thromboplastin time; INR = international normalized ratio; PCC = prothrombin complex concentrate; PT = prothrombin time; rFVIIa = recombinant fact Vlla.

Temporary discontinuation for surgery and
other procedures*

If XARELTO® must be discontinued for a procedure, follow these guidelines:

XARELTO® (rivaroxaban) guidelines before procedure

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
XARELTO® (rivaroxaban) guidelines after procedure

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

The half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in elderly subjects aged 60 to 76 years.

*This is not intended to replace clinical judgment or determine individual patient care.

Other administration options

Other oral administration options for XARELTO® (rivaroxaban) for adult patients

Oral administration of crushed XARELTO® tablets for adult patients

1Crush XARELTO® tablet

2Mix with applesauce

3Administer orally immediately

4Follow 15-mg and 20-mg doses immediately with food (not required for 2.5-mg or 10-mg dose)

Other administration options via nasogastric (NG) or gastric feeding tube for XARELTO® (rivaroxaban) for adult patients

Administration of XARELTO® via NG or gastric feeding tube for adult patients

1Confirm tube placement

2Suspend crushed XARELTO® tablet in 50 mL of water

3
  • Administer immediately
  • Avoid administration distal to stomach

4Follow 15-mg and 20-mg doses immediately by enteral feeding (not required for 2.5-mg or 10-mg dose)

NG = nasogastric. 

You may also be interested in:

REFERENCE: 1. XARELTO® [prescribing information]. Titusville, NJ: Johnson & Johnson.