Rivaroxaban and Spinal Anaesthesia — FRCA Final MCQ

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ModerateRegional AnaesthesiaRivaroxaban and Spinal AnaesthesiaFRCA Final

A 70-year-old woman (ASA III) is scheduled for total knee replacement. She takes rivaroxaban 20 mg once daily for atrial fibrillation. Her eGFR is 65 mL/min. What is the minimum time from last rivaroxaban dose to spinal anaesthesia?

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Correct answer: C — 24 hours

For rivaroxaban (a direct factor Xa inhibitor), the recommended minimum interval before neuraxial blockade is at least 24 hours after the last dose with normal renal function. With moderate renal impairment (eGFR 30-50), at least 36-48 hours is recommended. At eGFR 65, 24 hours is generally considered adequate. Anti-Xa levels can be checked if there is uncertainty about clearance. Rivaroxaban should not be restarted until at least 6 hours after catheter removal.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and abnormalities of coagulation; ESA – 2022 – Anticoagulant perioperative management