I am on long term rivaroxyban (for recurrent P Es). I now need to have major surgery. What advice has anyone been given about stopping

[Wagnerm]

and restarting rivaroxyban? I react badly to Warfarin but would be happy to use heparin temporally.

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Hi Wagnerm. I understand your concern as I have had 3 lots of surgery in the last 18 months and needed what they call "Anticoagulation Bridging" each time. Each Health Authority tends to have its own Anticoagulation Bridging Protocol and they vary enormously. Not surprisingly most surgeons are more concerned about high risks of bleeding rather than the problem for which the anticoagulant is prescribed.

In most cases you will need to stop your anticoagulant well before surgery . In the case of Warfarin that is usually 5 or 6 days before surgery but with Rivaroxyban, which has a much shorter "half-life" it is likely to be only around 48 hours before surgery. Once the therapeutic benefit of the Rivaroxyban has been lost, i.e. after 12 to 18 hours most will give you injections of a form of Heparin called Dalteparin (Branded as Clexane or Fragmin perhaps) once or twice daily and this is stopped 12 hours before surgery. This is a simple injection which you can give yourself if you wish). 12 Hours after surgery, provided there is no bleeding problem you can start the Rivaroxyban again and you will be protected after 6 to 12 hours.

The problem is that anticoagulation is a complicated business and not all clinicians and leading Nurses understand it well so my advice is to ensure that the precise and detailed Anticoagulation Bridging plan is spelled out and understood before you start and then you or your family should keep a very close eye on what happens to ensure that they stick to the agreed plan.

All the best and do please let us know how you get on. Peter

[Wagnerm]

Peter - thanks so much for your comprehensive reply. I have pre-ad clinic on Friday so I am now well informed for this!