Treatment Considerations | XARELTO® (rivaroxaban) HCP

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*

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:

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

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

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)

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

1Confirm tube placement

2Suspend crushed XARELTO® tablet in 50 mL of water

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.

XARELTO® (rivaroxaban) management1

You may also be interested in:

XARELTO® (rivaroxaban) management¹