Medications

Rivaroxaban (Xarelto) Before Surgery

Rivaroxaban is a once-daily DOAC. Like other DOACs, it's paused for a short, specific window before surgery based on bleeding risk and kidney function.

Medically reviewed by Dr. Saurabh Shukla, MBBS, DNB Anesthesiology · Last updated June 2026

Quick answer

Anesthesia guidelines (ASRA) recommend stopping rivaroxaban about 72 hours (3 days) before surgery — and especially before a spinal, epidural, or nerve block — with longer holds if your kidney function is reduced. It usually needs no bridging. Some lower-risk general surgery may allow a shorter hold, so confirm your exact timing.

Why it matters

Rivaroxaban blocks clotting factor Xa and clears within a day or two, so a short pause restores normal clotting for surgery while minimising the time you're unprotected.

It is partly cleared by the kidneys, so reduced kidney function makes it last longer and the stop time may need to be earlier.

Do not stop without instruction

The exact timing depends on your kidney function and the surgery's bleeding risk — don't decide it yourself.

What to ask your doctor

  • How many hours before surgery do I stop rivaroxaban?
  • Does my kidney function change the timing?
  • When do I restart it afterward?
  • Is bridging needed (usually not)?

Red flags — call your team

Red flags — call your team

  • Reduced kidney function
  • Previous clot, stroke, or mechanical heart valve
  • Unusual bleeding before surgery

References

  • American Society of Regional Anesthesia (ASRA) — anticoagulation guidelines.
  • American College of Cardiology (ACC) — periprocedural DOAC management. acc.org

Frequently asked questions

How long before surgery do I stop Xarelto?

Anesthesia (ASRA) guidance is about 72 hours (3 days), longer with kidney impairment — particularly if a spinal or epidural is planned. Some general surgery may use a shorter hold, so follow your team's exact plan.

Calculate your exact fasting window Now get the precise times to stop eating & drinking before your surgery.

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