When to stop taking Xarelto (rivaroxaban) before a finger cyst excision procedure?

When to Stop Xarelto Before Finger Cyst Excision

Stop Xarelto (rivaroxaban) 1 day before your finger cyst excision procedure, taking your last dose on the morning of the day before surgery. 1

Procedure Risk Classification

Finger cyst excision is classified as a low-to-moderate bleeding risk procedure based on the American College of Chest Physicians perioperative guidelines. 1 This classification determines the duration of anticoagulation interruption needed.

Standard Interruption Protocol

• Take your last dose of Xarelto on the morning of the day before the procedure (approximately 24 hours before surgery). 1, 2

• Do not take Xarelto on the day of the procedure itself. 1

• This 1-day interruption allows for adequate clearance of rivaroxaban, which has a half-life of 7-11 hours in most patients. 3

Critical Considerations for Renal Function

• If you have normal kidney function (creatinine clearance ≥50 mL/min), the standard 1-day interruption is appropriate. 1

• If you have impaired kidney function (creatinine clearance <50 mL/min), consider extending the interruption to 2 days before the procedure, as rivaroxaban clearance is slower with renal impairment. 2

• Rivaroxaban has dual excretion with one-third eliminated unchanged through the kidneys, making renal function assessment critical. 3

What NOT to Do: Common Pitfalls

• Never use bridging anticoagulation with heparin or low molecular weight heparin when stopping Xarelto for this procedure. 1, 4 The rapid offset and onset of rivaroxaban makes bridging unnecessary and dramatically increases bleeding risk without reducing thrombotic risk. 1

• Do not double your dose or take extra doses to "catch up" if you miss a dose during the perioperative period. 5

Resuming Xarelto After the Procedure

• Resume Xarelto at least 24 hours after the finger cyst excision, once adequate hemostasis is confirmed and there is no ongoing bleeding. 1, 2

• Rivaroxaban has a rapid onset of action with peak effect occurring 2-4 hours after intake, so cautious timing of resumption is essential. 1, 3

• Take your regular dose at the scheduled time once the 24-hour post-procedure window has passed and your surgeon confirms adequate wound healing. 5

Dosing Schedule Considerations

• If you take Xarelto once daily in the morning: Skip the dose on the day before surgery (after taking your morning dose) and the day of surgery. 2

• If you take Xarelto once daily in the evening: Your last dose should be taken two evenings before the procedure. 2