Rivoxan Special Precautions

Most common complication is bleeding; major hemorrhages (eg. Intracranial, GI, retinal, epidural hematoma, adrenal bleeding) have been reported. Monitor for signs and symptoms of bleeding.
Spinal or epidural hematomas may occur with neuraxial anesthesia (epidural or spinal anesthesia) or spinal puncture in patients who are anticoagulated; may result in long-term or permanent paralysis.
As with any oral anticoagulant in the absence of adequate alternative anticoagulation, an increased risk of thrombotic events (including stroke) may occur with premature discontinuation of rivaroxaban. Consider the addition of alternative anticoagulant therapy when discontinuing rivaroxaban for reasons other than pathological bleeding or completion of a course of therapy.
Avoid use in patients with moderate to severe hepatic impairment (Child-Pugh classes B and C) or in patients with any hepatic disease associated with coagulopathy.
Use with caution in patients with moderate renal impairment (CrCl 30 to 50 mL/minute) when used for postoperative thromboprophylaxis, including patients receiving concomitant drug therapy that may increase rivaroxaban systemic exposure and those with deteriorating renal function.
Discontinue rivaroxaban at least 24 hours prior to surgery/invasive procedures. Some have recommended to discontinue rivaroxaban 3 days prior to a procedure in patients with a CrCl ≥ 50 mL/minute or 5 days prior in patients with a CrCl < 50 mL/minute.
Use in the Elderly: Use with caution in the elderly.