Management of Missed Doses of Xarelto (Rivaroxaban)

General Guidelines

The European Society of Cardiology recommends taking the missed dose as soon as possible once noticed, but only on the same day, to maintain therapeutic blood levels without causing excessive anticoagulation 1
For patients with high thrombotic risk (CHA₂DS₂-VASc score ≥3), taking the missed dose is particularly important to maintain anticoagulation, according to the European Heart Journal 1
For patients with lower thrombotic risk (CHA₂DS₂-VASc score <2), waiting until the next scheduled dose may be reasonable if it's close to the next dosing time, as suggested by the European Heart Journal 1

If uncertain about dose intake for a once-daily regimen and having high thrombotic risk, the European Heart Journal suggests taking another tablet and continuing the planned schedule 1
If multiple consecutive doses are missed, the American College of Chest Physicians recommends contacting a healthcare provider immediately for guidance, as patients may need more specific instructions based on their medical condition and risk factors 2