What should be considered when stopping Xarelto®?
introduction
Xarelto® is a trade name for the active ingredient rivaroxaban. This is an anticoagulation drug, which is colloquially a blood thinner.
The intake is strictly adjusted by the attending family doctor and should not be discontinued without his instruction. However, discontinuation of Xarelto® is required in certain circumstances. This should also only be done on the advice of the doctor. Discontinuing Xarelto® can lead to serious complications.
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What should be considered when stopping Xarelto®?
Xarelto® is an active ingredient that is prescribed by the treating family doctor with good reason. Discontinuation should never be carried out without consulting a doctor. After stopping Xarelto®, the risk of blood clots increases significantly and those affected can develop strokes, heart attacks, vascular occlusions and many other life-threatening complications.
In the event of intolerance to Xarelto®, a new active ingredient should therefore be used immediately and not just Xarelto® discontinued. The time without treatment with anticoagulants should be made as short as possible. If the medication is changed, the risk of bleeding also increases, which is a major problem with Xarelto®, as there is no direct antidote for Xarelto®.
If there are signs of bleeding, a doctor should be consulted immediately. The effect of Xarelto® decreases significantly after a few hours to days after stopping it and must therefore be carefully monitored. However, it is not necessary to check the blood levels while taking or stopping Xarelto®.
Read more on the subject here: Xarelto® and alcohol
When do I have to stop taking Xarelto®?
There are several reasons why Xarelto® must be permanently or temporarily discontinued. In some procedures with a high risk of bleeding, anticoagulants must be discontinued beforehand, if this is responsible. Small interventions such as dental operations are often carried out despite Xarelto®.
For major operations, Xarelto® must be discontinued one to two days in advance. The exact time should be clarified with your anesthetist in the preliminary discussion. After the procedure, Xarelto® should be taken again as soon as possible after consultation with the doctor. If discontinuation is too risky, the need for surgery must be clarified.
If kidney dysfunction is above a certain level, Xarelto® must also be discontinued, since half of Xarelto® is eliminated through the kidneys.
In the event of acute or chronic bleeding, for example in the gastrointestinal tract, a doctor should be consulted and discussed whether Xarelto® should be discontinued.
Xarelto® should also not be used during pregnancy and breastfeeding.
In the event of serious side effects or allergic reactions to the ingredients of Xarelto®, an alternative to anticoagulation with Xarelto® should be discussed and Xarelto® should be discontinued.
Read more on the topic: Anticoagulants
How quickly does the effect of Xarelto® disappear?
The half-life of Xarelto® is between five and thirteen hours. This means that half of the active ingredient can no longer be detected. However, the exact end of the effect depends on the biological half-life. Many individual factors play a role, such as kidney function and the age of the person affected.
It is therefore not possible to give an exact time.A safety interval of around 24 hours is planned before operations, as the effect is then normally weakened enough.
Read more about here: Xarelto®
Is bridging necessary?
Bridging means interrupting medication for a short period of time. This may be necessary for anticoagulants before surgery. Small interventions, such as dental operations, can be carried out without bridging.
However, major operations are associated with a high risk of bleeding and therefore cannot be performed while the patient is still taking anticoagulants. The intake is interrupted for a few days. Since this carries a high risk of complications, the need for the operation must be strictly controlled.
In emergency operations, the urgency of the operation must be weighed against the risk of bleeding.
Is there an antidote?
While the new oral anticoagulants, which include Xarelto®, have many advantages over other anticoagulants, there is also one major disadvantage. There is no antidote for Xarelto®. Filtering out the drug by dialysis is also not promising due to its chemical properties.
In the event of severe side effects and bleeding, those affected must therefore be treated symptomatically. The bleeding can be treated with compressions and local or systemic hemostatic drugs as well as blood reserves, and in the case of allergic reactions, the classic antihistamines and cortisol should be used.
Since Xarelto® has a relatively short half-life, the active ingredient disappears from the blood after a few hours if it is not taken and normal blood clotting resumes. In the event of an acute overdose, as long as this is noticed in good time, activated charcoal can be used to bind medication present in the stomach. This is a measure that can be used, for example, when children have taken their parents 'or grandparents' medication.
Read more about the topic here: Anticoagulants
