When to resume Xarelto (rivaroxaban) after a facelift in a patient with a history of Deep Vein Thrombosis (DVT)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: April 15, 2025 • View editorial policy

From the Guidelines

Resuming Xarelto after a facelift for a patient with a history of DVT should be considered approximately 48-72 hours post-procedure, depending on the patient's specific risk factors and the surgeon's assessment of bleeding risk. When considering the resumption of anticoagulation therapy, such as Xarelto, after surgical procedures like a facelift, it's crucial to balance the risk of thrombotic events against the risk of bleeding complications. According to the American College of Chest Physicians clinical practice guideline from 2022 1, direct oral anticoagulants (DOACs) like Xarelto can be resumed approximately 24 hours after low to moderate bleed-risk procedures and 48-72 hours after high-bleed-risk procedures.

Given that a facelift may be considered a procedure with a moderate risk of bleeding, the guideline suggests that resumption of DOACs could be considered around 24 hours post-procedure. However, for patients with a history of DVT, the risk of recurrent thrombosis must be carefully weighed against the risk of bleeding. In selected patients at high risk for venous thromboembolism (VTE), low-dose anticoagulants can be administered for the first 48-72 hours post-procedure, as an alternative or bridge until the resumption of the regular anticoagulant regimen.

Key factors influencing the decision on when to resume Xarelto include:

  • The patient's specific thrombotic risk factors, such as the timing of the last DVT, presence of thrombophilia, or history of multiple DVTs.
  • The extent of surgical dissection and the surgeon's assessment of the patient's risk for postoperative bleeding.
  • The presence of any postoperative bleeding or the output from surgical drains.

Collaboration between the surgeon and the prescribing physician is essential to make an informed decision that minimizes both the risk of recurrent thrombosis and bleeding complications, thus optimizing the patient's outcome in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

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 [see Dosage and Administration (2.3, 2.4), Warnings and Precautions (5.1), and Clinical Studies (14. 1)] .

The FDA drug label does not provide specific guidance on when to resume XARELTO after a face lift for a patient with a history of DVT.

  • Key consideration: The label warns against premature discontinuation of XARELTO, which increases the risk of thrombotic events.
  • Clinical decision: In the absence of direct guidance, a conservative approach would be to consider alternative anticoagulation coverage during the period of XARELTO discontinuation, taking into account the patient's individual risk factors and the timing of the face lift procedure 2.

From the Research

Resuming Xarelto after Face Lift for Patient with History of DVT

  • The decision to resume Xarelto after a face lift for a patient with a history of deep vein thrombosis (DVT) should be based on the individual patient's risk factors and medical history 3.
  • Studies have shown that patients with a history of DVT are at increased risk of recurrent venous thromboembolism (VTE) 4, 5.
  • The use of Xarelto (rivaroxaban) has been shown to be effective in preventing recurrent VTE in patients with a history of DVT 4, 5.
  • However, the risk of bleeding associated with Xarelto should also be considered, particularly in patients undergoing surgical procedures such as face lift 6, 7.
  • The American Society for Aesthetic Plastic Surgery recommends the use of intermittent compression devices for VTE prophylaxis in patients undergoing face lift under general anesthesia 3.
  • The timing of resuming Xarelto after face lift should be individualized based on the patient's risk factors and medical history, and should be discussed with the patient's healthcare provider 4, 5.
  • Some studies suggest that Xarelto can be resumed 24 hours after surgery, but this should be determined on a case-by-case basis 6, 7.
  • Patients with a history of DVT should be closely monitored for signs and symptoms of VTE and bleeding after resuming Xarelto 4, 5.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.