title: Periprocedural management of rivaroxaban-treated patients.
abstract: BACKGROUND
  The increasing and widespread use of direct oral anticoagulants (DOACs) demands guidelines and experts' consensus for their rational and safe use, especially in certain situations for which there is no evidence-based consensus, such as the periprocedural setting. Rivaroxaban is an oral factor Xa inhibitor approved for stroke prevention in atrial fibrillation (AF) and for treatment and prevention of venous thromboembolism (VTE) in major orthopedic surgery. This article is addressed to all the clinicians involved in the periprocedural approach of patients treated with rivaroxaban, with the aim to give practical recommendations to improve patients' management during and after surgery.
  
  
  METHODS
  This article is based on a consensus of specialists involved in anticoagulant treatment and in periprocedural setting, including experts in thrombosis, cardiologists, internists, clinical pathologists and anesthesiologists. The authors performed a review of the literature and expressed statements based on the results of the review as well as on personal experience.
  
  
  CONCLUSIONS
  Rivaroxaban is a safe and effective drug that simplifies management of anticoagulation also in patients undergoing invasive procedures. However, periprocedural management could be challenging and physicians must carefully balance the risk of bleeding and the risk of thrombosis.
authors.affiliation: Internal Medicine, Haemostasis and Thrombosis Center, Ospedale di Piacenza , Via Taverna, 49, Piacenza , Italy +39 523 302578 ; +39 523 302595 ; d.imberti@ausl.pc.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Imberti
authors.forename: Andrea
authors.initials: A
authors.lastname: Ambrosoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Cimminiello
authors.forename: Christian
authors.initials: C
authors.lastname: Compagnone
authors.forename: Andrea
authors.initials: A
authors.lastname: Fanelli
authors.forename: Armando
authors.initials: A
authors.lastname: Tripodi
authors.forename: Filippo
authors.initials: F
authors.lastname: Ottani
mesh_terms: D000284:Administration, Oral; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control; D012306:Risk; D000069552:Rivaroxaban; D013514:Surgical Procedures, Operative; D013876:Thiophenes / Q000627:therapeutic use*; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban
keywords: anesthesia; direct oral anticoagulants; periprocedural management; rivaroxaban; surgery