For which operations do I have to discontinue Xarelto®? | Xarelto®

For which operations do I have to discontinue Xarelto®?

Before surgery, it must be carefully considered whether the risk of bleeding or thrombosis is predominant. For major operations with impending blood loss, Xarelto® must be discontinued beforehand; for minor operations, such as dental surgery, Xarelto® can usually continue to be taken. Major operations that are not absolutely necessary should only be performed if the risk of thrombus formation can be controlled in some other way. Whether Xarelto® has to be discontinued should be clarified in the preliminary consultation with the patient’s surgeon and anesthetist.

Dosage of Xarelto®

The dosage of Xarelto® depends on various factors. Xarelto® 20mg is administered once daily for the prevention of stroke in atrial fibrillation. The dosage can be reduced if kidney function is poor.

For the treatment of deep vein thrombosis in the leg, the following dosage regimen is used: During the first 21 days, patients take 15mg Xarelto® twice daily and from day 22 onwards, 20mg once daily. After the six-month treatment, Xarelto® is passed on for prophylaxis only and reduced to 10 or 20 mg once daily. In the case of kidney damage, the dose must be reduced because the active ingredient is broken down more slowly. Depending on the indication for Xarelto®, the dosage may vary.

Is there an antidote?

Xarelto® has a strong influence on blood coagulation and can therefore also lead to heavy bleeding as a side effect. In addition, acute illnesses or accidents requiring emergency surgery can be dangerous when taking Xarelto. However, Xarelto® cannot be antagonized, which means that there is no antidote.

This is a problem both in cases of bleeding complications and overdoses. Bleeding can therefore only be treated symptomatically. Bleeding can be controlled by manual pressure on a bleeding wound or local coagulants.

When taken directly, activated carbon can bind the unabsorbed amounts of the active ingredient in the gastrointestinal tract, thus preventing it from being absorbed into the blood. This is one way of reducing the effect of Xarelto®, particularly if it is taken accidentally. The lack of an antidote is a disadvantage of the new oral anticoagulants, as classic Marcumar can be antagonized with vitamin K. However, Xarelto® has a short half-life so that the active ingredient is broken down by the body itself in a few hours to days, and bleeding only has to be kept under control until then.