A 66-year-old man with nonvalvular atrial fibrillation takes rivaroxaban 20 mg once daily. He is scheduled for elective lumbar discectomy with spinal anaesthesia. When should his last dose be taken?
- A 12 hours before the procedure
- B 72 hours before the procedure ✓
- C 24 hours before the procedure
- D Rivaroxaban need not be stopped for neuraxial blockade
Correct answer: B. 72 hours before the procedure
Explanation
Direct oral factor Xa inhibitors must be withheld longer than standard for neuraxial techniques because there is no routine laboratory test to confirm haemostatic recovery and spinal hematoma is catastrophic. Consensus guidance (ASRA) advises omitting rivaroxaban for 72 hours before neuraxial blockade or major surgery. Twenty-four hours may suffice for minor procedures with negligible bleeding risk, but not for spinal surgery. Bridging with heparin is not required for DOACs of this kind.
Reference: Miller's Anesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.