Atrial Fibrillation: Rivaroxaban Therapy Before, During, and After a Colonoscopy

Eric Dietrich, PharmD, BCACP, CPC - A, CEMC, CPB | Pharmacist and Clinical Associate Professor, Department of Pharmacotherapy and Translational Research, University of Florida

A 71-year-old White woman with a history of atrial fibrillation presented to your clinic to discuss her rivaroxaban regimen in relation to an upcoming colonoscopy procedure. She currently takes rivaroxaban, 20 mg, once daily in the evening. The gastroenterology team informed her that she needed to be off of her rivaroxaban regimen for the procedure but asked her to get specific instructions from her primary care provider about when to stop the rivaroxaban.

Upon presentation, she felt well overall. Her blood pressure was 128/74 mm Hg, pulse was 59beats/min, height was 1.9 m, weight was 93.4 kg,and pulse oximetry was 94% on room air. Her medical history was significant for hypertension, atrial fibrillation, and heart failure with preserved ejection fraction. Her CHA2DS2-VASc score was 4. Her current medications included rivaroxaban, 20mg, daily; lisinopril,20 mg, daily; rosuvastatin, 20 mg, daily; carvedilol, 25 mg, twice daily; and aspirin, 81 mg, daily.

She had not missed any doses of her rivaroxaban, has not had any unusual bleeding or bruising,continues to avoid nonsteroidal anti-inflammatory drugs, and reports that the cost of the rivaroxaban is acceptable. She recently completed blood work, including a comprehensive metabolic panel, results of which were within normal limits except for an elevated level of creatinine at 1.26 mg/dL(calculated creatinine clearance of 50 mL/min). She can adhere to any instructions related to her rivaroxaban in preparation for the procedure.