In situations where a patient requires a surgical intervention or invasive procedure (including tooth extraction), LIXIANA® should be stopped as soon as possible and preferably at least 24 hours beforehand, and appropriate caution exercised due to the increased risk of thrombosis. The half-life of LIXIANA® is 10–14 hours. As LIXIANA® is a reversible Factor Xa inhibitor, its anticoagulant activity should lessen within 24–48 hours of the last administered dose.
In deciding whether a procedure should be delayed until 24 hours after the last dose of LIXIANA®, the increased risk of bleeding should be weighed against the urgency of the intervention. LIXIANA® should be restarted after the surgical or other procedures as soon as adequate haemostasis has been established, noting that the time to onset of the LIXIANA® anticoagulant therapeutic effect is 1–2 hours. If oral medicinal products cannot be taken during or after surgical intervention, consider administering a parenteral anticoagulant and then switch to oral once daily LIXIANA®.