Ideally, Xarelto (rivaroxaban) should be stopped at least 24 hours before surgery in a person with normal renal function who is undergoing a low-bleeding-risk procedure, or 48 to 72 hours before surgery if the procedure is high-risk. For somebody with impaired renal function (CL_CR of 30-50 ml/min) undergoing a low bleeding risk procedure, Xarelto should be stopped 48 hours before, or 48-72 hours before if the procedure is high risk. Specialist advice should be sought regarding when to stop Xarelto in people with severely impaired renal function undergoing any procedure.

If you need emergency surgery, and it has not been at least 24 hours since you last took Xarelto, then your surgeon needs to weigh up the increased risk of bleeding against the benefits of immediate surgery.

Restarting Xarelto after surgery

After surgery, Xarelto can be restarted as soon as any postoperative bleeding has stopped. As a guide, this is usually one day after surgery for low to moderate-risk procedures or two days after surgery for high bleeding-risk procedures. If a person cannot take oral medication, then an anticoagulant given by injection should be considered. Xarelto acts quickly, and the type of surgery that was performed and other risk factors for bleeding should be taken into account.