How to get off Xarelto? (3+ precautions)
In this article, we will discuss how to discontinue the use of Xarelto safely. We will cover the complications associated with the sudden discontinuation of Xarelto and the precautions to be taken while discontinuing the drug.
How to get off Xarelto?
You can normally stop taking the regular dose of Xarelto. Xarelto does not necessarily need to be tapered before discontinuation. However, discontinuation of Xarelto comes with a risk of bleeding, and the decision to discontinue Xarelto should be made under the guidance of a physician. It is not recommended to stop taking Xarelto before completion of the treatment course as it can increase the risk of stroke and myocardial infarction.
In some situations, Xarelto is given for the duration of 3-6 months and then slowly tapered and discontinued to avoid any complications and withdrawal symptoms. Xarelto is an oral anticoagulant which is used as a prophylaxis treatment to prevent blood clots in the body, which can lead to stroke-like life-threatening conditions. (1)
What does the research suggest?
In a study conducted by Manesh R. Patel et al. to analyse the outcome of possible risks associated with the discontinuation of anticoagulants rivaroxaban and warfarin reported that patients with atrial fibrillation who discontinued rivaroxaban temporarily or permanently had an increased risk of stroke and non-CNS embolism when compared with warfarin. (2)
A case study by Nagasayi et al. reported rebound hypercoagulability, which led to an upper extremity deep vein thrombosis upon rivaroxaban withdrawal. An 88-year-old woman who was on rivaroxaban for atrial fibrillation presented to the hospital with painless swelling of the left upper limb and intermittent facial swelling. Investigations revealed thrombosis, following which rivaroxaban was reintroduced. (3)
A case study by Turner et al. reported a large left middle cerebral artery infarct upon temporary discontinuation of the rivaroxaban. Agarwala et al. reported myocardial infarction when rivaroxaban was stopped for 12 days after post-knee replacement surgery. (4,5)
When can you stop taking Xarelto?
Xarelto (rivaroxaban) is used for patients undergoing orthopaedic surgery, postoperative prophylaxis for DVT and stroke prevention in individuals with cardiac arrhythmia and atrial fibrillation and also to reduce the risk of clotting in venous thromboembolism. (1)
Xarelto is prescribed for a few weeks to months in certain cases and then discontinued. For example, for prophylaxis of DVT, Xarelto is given for 3-6 months and then discontinued. Similarly, for thrombophlebitis, Xarelto is given for 6 weeks and 3 weeks for acute VTE treatment.
The duration of Xarelto’s treatment depends upon your condition. Anticoagulants such as Xarelto are discontinued at least 24 hours before surgery and invasive procedures to avoid the risk of bleeding and can be restarted after the procedure. (1)
Discontinuation of Xeralto or any alteration to the anticoagulant treatment should be done by a qualified physician as it carries an increased risk of bleeding, stroke and MI.
What are the things you should know before stopping Xarelto?
Xarelto acts by thinning the blood and preventing the build-up of clots in the body, which can be a potential threat. Discontinuing Xarelto mid-treatment can increase the risk of thrombosis (blockage of blood vessels due to clot formation), which can lead to stroke and myocardial infarction.
It is important to consult a healthcare physician before making any alteration to your anticoagulant regimen. Do not stop taking Xarelto abruptly. If you missed a dose of 2.5mg of Xarelto, take a single dose at the next scheduled time. If you have been prescribed a total dose of 30mg in two divided doses and you missed a dose, take it immediately and ensure you consume 30mg per day. Do not take more than the prescribed dose. (6)
What are the precautions to be taken during Xarelto treatment?
There are some precautionary measures to be taken while taking Xarelto and while discontinuing the drug.
- Always take the drug that has been prescribed by your physician at the same time every day.
- Do not stop taking the drug without consulting your physicain, as it can increase the risk of stroke and MI.
- Stopping the drug can put you at risk of a few complications. Make sure you seek medical help if you notice any abnormalities such as swelling in your legs or face, pain, dizziness, lightheadedness, altered mental status, etc.
- Xarelto comes with a risk of bleeding, so look out for bruises and any activities where you can get hurt.
- If you are undergoing any dental surgeries or any minor procedure, make sure you tell your dentist about your anticoagulant therapy.
- Avoid eating grapefruit and juice as they can increase the levels of Xarelto in your body and enhance the risk of bleeding.
- Avoid eating oats, ginger, St. John’s wort, mango, and garlic in excess amounts, as they can increase the plasma concentration of Xarelto.
- If you notice any unwanted side effects during your treatment with Xarelto, such as bleeding, dizziness, insomnia, etc., consult your physician.
- Xarelto can interact with certain medications such as sertraline, fluoxetine OTC medications such as clopidogrel, NSAIDs (ibuprofen/naproxen), mifepristone, etc. Make sure you consult your physician before taking any OTC medication.
As per my knowledge, depending upon your condition, the treatment duration of Xarelto is decided, and it is important to consult a physician before discontinuing Xarelto to avoid any complications. Your physician will assess your condition and provide you with proper management. It is not recommended to stop taking the drug suddenly.
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Singh R, Emmady PD. Rivaroxaban. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557502/
Patel MR, Hellkamp AS, Lokhnygina Y, Piccini JP, Zhang Z, Mohanty S, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ. Outcomes of discontinuing rivaroxaban compared with warfarin in patients with nonvalvular atrial fibrillation: analysis from the ROCKET AF trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). Journal of the American College of Cardiology. 2013 Feb 12;61(6):651-8. Available from: https://pubmed.ncbi.nlm.nih.gov/23391196/
Nagasayi S, Varman S, Ting YY, Ang W. Rivaroxaban withdrawal and rebound hypercoagulability leading to upper extremity deep vein thrombosis: a case report. Age and Ageing. 2017 Sep 1;46(5):870-1. Available from: https://academic.oup.com/ageing/article/46/5/870/3791763
Turner M, Solarz D. Left atrial thrombus formation after brief interruption of rivaroxaban. The American Journal of Emergency Medicine. 2015 May 29;34(1):116-e3. Available from: https://europepmc.org/article/med/26081413
Agarwal A, Patel A, Mufti O, Jbara Y, Jabbar AA. Rivaroxaban rebound acute coronary event: a post marketing experience. Cardiology Research. 2013 Dec;4(6):207. Available from: https://europepmc.org/article/med/26081413
Xarelto [package insert]. Titusville: Janssen Pharmaceuticals, Inc; 2021. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215859s000lbl.pdf