Management of Rivaroxaban for Colonoscopy

Discontinuation Protocol

Rivaroxaban should be discontinued 3 days before colonoscopy for patients with normal renal function (CrCl >30 mL/min) 1, 2
For patients on once-daily rivaroxaban regimen (morning dose): Last dose should be taken on the morning of the day before the procedure 3, 4
For patients on once-daily rivaroxaban regimen (evening dose): Last dose should be taken two days before the procedure 3, 4
For patients on twice-daily rivaroxaban regimen: Last dose should be taken on the morning of the day before the procedure 3
No bridging with heparin is recommended during this interruption period 1, 2
Check that rivaroxaban has adequately cleared before the procedure (though specific testing is not routinely required) 6

For patients with impaired renal function (CrCl 30-50 mL/min), consider a longer discontinuation period 7
Patients with severely impaired renal function may require additional days of discontinuation due to prolonged drug clearance 6
For procedures with very high bleeding risk, consider discontinuing rivaroxaban for up to 5 days prior to the procedure 1, 5

For low bleeding risk colonoscopy without polypectomy: Resume rivaroxaban at least 6 hours after the procedure 3, 2
For high bleeding risk colonoscopy or after polypectomy: Resume rivaroxaban 24-72 hours after the procedure, once adequate hemostasis is confirmed 7, 5

Colonoscopy with potential polypectomy requires a longer discontinuation period due to the increased bleeding risk 8
No preoperative bridging with heparin is recommended for most patients 3, 2
Failing to account for renal function when determining discontinuation timing may lead to increased risk 6, 5
Unnecessarily prolonged discontinuation, which may increase thrombotic risk 3, 2