From the Guidelines
Recommended Duration to Withhold Xarelto (Rivaroxaban) Before FNA
It is recommended to hold Xarelto (rivaroxaban) for at least 1 day before a Fine Needle Aspiration (FNA) procedure, as FNA is generally considered a low-to-moderate-bleed-risk procedure 1.
- The management of rivaroxaban interruption is based on the bleed risk associated with the surgery/procedure 1.
- For FNA, which falls into the low-to-moderate-bleed-risk category, interrupting rivaroxaban for 1 day before the procedure is considered sufficient 1.
- This recommendation applies irrespective of whether patients are receiving rivaroxaban for atrial fibrillation or VTE 1.
- The dosage of Xarelto does not affect the recommended duration of withholding the medication before an FNA procedure, as the guideline provides a uniform recommendation for low-to-moderate-bleed-risk procedures 1.
From the Research
Recommended Duration to Withhold Xarelto (Rivaroxaban) Before a Fine Needle Aspiration (FNA)
- There is no specific recommended duration to withhold Xarelto (rivaroxaban) before a Fine Needle Aspiration (FNA) mentioned in the provided studies.
- However, studies suggest that it may not be necessary to discontinue anticoagulation medication, including rivaroxaban, before FNA procedures 2, 3, 4.
- One study concluded that patients on novel oral anticoagulants, including rivaroxaban, can safely undergo USGFNAB without discontinuing their medication 3.
- Another study found that cessation of anticoagulation medication before thyroid FNA is not necessary to obtain sufficient cellular material for diagnosis 4.
Considerations for Anticoagulation Management
- The decision to withhold anticoagulation medication before a procedure should be made on a case-by-case basis, taking into account the individual patient's risk of bleeding and thromboembolic events 5.
- Validated bleeding risk assessments, such as HAS-BLED, should be performed to identify patients at high risk of bleeding 5.
- Reversal agents, such as idarucizumab for dabigatran and andexanet alfa for rivaroxaban and apixaban, are available in case of major bleeding 5.