Rivaroxaban Discontinuation and Resumption Protocol for Foot Surgery

Discontinuation Timeline

For patients undergoing foot surgery with low to moderate bleeding risk, the American College of Chest Physicians recommends discontinuing rivaroxaban 1 day before the procedure, with the last dose taken on the morning of the day before surgery, and no bridging with heparin is required during this interruption period 1, 3
For patients undergoing foot surgery with high bleeding risk, discontinuation of rivaroxaban 2 days before the procedure is recommended, and for those with impaired renal function, consideration of extending the discontinuation period is advised 1, 3

The Anaesthesia society recommends that standard discontinuation times apply to patients with normal renal function, and for patients with impaired renal function, longer discontinuation periods are recommended due to slower drug clearance, with timing of interruption accounting for creatinine clearance using the Cockcroft and Gault formula 3
For once-daily morning dosing, the last dose should be taken on the morning of the day before the procedure, and for once-daily evening dosing, the last dose should be taken two days before the procedure, with consideration of the dosing schedule to ensure appropriate discontinuation timing 2

After foot surgery, the American College of Chest Physicians recommends resuming rivaroxaban at least 24 hours after low bleeding risk procedures, and 48-72 hours after high bleeding risk procedures, once adequate hemostasis is confirmed, to minimize the risk of thrombotic events 1

Failing to account for renal function when determining discontinuation timing can lead to increased bleeding risk, and unnecessarily prolonged discontinuation may increase thrombotic risk, highlighting the importance of careful consideration of anticoagulation management 1, 3