These include aspirin, P2Y 12 platelet inhibitors, dual antiplatelet therapy, other antithrombotic agents, fibrinolytic therapy, NSAIDs, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs). Because of high plasma protein binding, rivaroxaban is not dialyzable.Ĭoncomitant use of other drugs that impair hemostasis increases risk of bleeding. Discontinue in patients with active pathological hemorrhage.Īn agent to reverse the anti-factor Xa activity of rivaroxaban is available. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Risk of Bleeding: XARELTO ® increases the risk of bleeding and can cause serious or fatal bleeding.If XARELTO ® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. An increased rate of stroke was observed during the transition from XARELTO ® to warfarin in clinical trials in atrial fibrillation patients. Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including XARELTO ®, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events.Severe hypersensitivity reaction to XARELTO ® (eg, anaphylactic reactions) If neurological compromise is noted, urgent treatment is necessary.Ĭonsider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis. Monitor patients frequently for signs and symptoms of neurological impairment. Optimal timing between the administration of XARELTO ® and neuraxial procedures is not known.A history of spinal deformity or spinal surgery.A history of traumatic or repeated epidural or spinal punctures.Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants, see Drug Interactions.Factors that can increase the risk of developing epidural or spinal hematomas in these patients include: Consider these risks when scheduling patients for spinal procedures. These hematomas may result in long-term or permanent paralysis. If anticoagulation with XARELTO ® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.Įpidural or spinal hematomas have occurred in patients treated with XARELTO ® who are receiving neuraxial anesthesia or undergoing spinal puncture. Premature discontinuation of any oral anticoagulant, including XARELTO ®, increases the risk of thrombotic events. Premature discontinuation of XARELTO ® increases the risk of thrombotic events WARNING: (A) PREMATURE DISCONTINUATION OF XARELTO ® INCREASES THE RISK OF THROMBOTIC EVENTS,Ī.
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