• Davide Imberti, Andrea Ambrosoli, Claudio Cimminiello, Christian Compagnone, Andrea Fanelli, Armando Tripodi, and Filippo Ottani.
• 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.
• Expert Opin Pharmacother. 2015 Apr 1; 16 (5): 685-91.

IntroductionThe 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.Areas CoveredThis 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.Expert OpinionRivaroxaban 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.

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