In which situation should you discontinue the use of rivaroxaban?

Discontinuing rivaroxaban during the planning for conception is crucial due to the potential risks to the fetus and the safety profiles of anticoagulants during pregnancy. Rivaroxaban is a direct oral anticoagulant (DOAC) that has not been adequately studied in pregnant women, which raises concerns about fetal development and the possibility of pregnancy-related complications. If a patient is planning to conceive, it is essential to consider switching to a more established anticoagulant that has a known safety profile during pregnancy, such as low molecular weight heparin (LMWH), ensuring the safety of both the mother and the potential fetus.

In contrast, discontinuing rivaroxaban due to significant bleeding events is also a valid consideration, as it may pose immediate health risks, but this situation often calls for careful management rather than outright discontinuation without further medical evaluation. The same applies to elevated INR levels—this is more relevant to vitamin K antagonists rather than rivaroxaban, which is not monitored using INR. Therefore, option C appropriately emphasizes the importance of considering the overall health implications of anticoagulant use in the context of pregnancy planning.