CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures

CIRSE Standards of Practice on Hepatic Transarterial Chemoembolisation

“…According to the Society of Interventional Radiology and CIRSE Standards of Practice documents on peri-procedural bleeding [45,46], TACE carries a moderate risk of bleeding. Therefore, INR should be corrected to less than 1.5, and platelets transfusion recommended for counts less than 50,000/ul, clopidogrel should be suspended for 5 days before the procedure.…”

Clinical Progress Note: Consolidated Guidelines on Management of Coagulopathy and Antithrombotic Agents for Common Bedside Procedures

“…In the case of LP, we included some regional anesthesia and pain procedure guidelines based on the assumption that certain procedures are analogous to LP and associated with similar bleeding risks. Some of the guidelines referenced do After 6 h 7,8 After 24 h 4,9 After 48-72 h 3,11 Apixaban Continue 2,3f,10 ≥24 h 5c,11d 24-48 h 3g ≥48 h 11c…”

“…After 6 h 3 Next day 11d After 48-72 h 11c Continue 2 24 h (5 mg/d dose) 7 24-48 h (20 mg/d dose) 7 24-48 h 3 ≥48 h 11 72 h 8,9 After 6 h 8 After 6 h (5 mg/d dose) 7 After 6-24 h (20 mg/d dose) 7 After 24 h 9 After 48-72 h 3,11 a For patients with clinically significant renal dysfunction, please see individual references for periprocedural hold and restart times. e Patient-specific bleeding risk factors include, but are not limited to, hypertension, abnormal renal function, abnormal hepatic function, prior stroke, history of major bleeding (especially within the preceding 3 months), and bleeding history with a similar procedure.…”

“…2 For platelet count, there are multiple recommendations for greater than 20,000/µL and one for greater than 50,000/µL. 2,3,5 The recommendations for continuation or suspension of antiplatelet and anticoagulant medications prior to thoracentesis are similar to those for paracentesis. In general, continuing antiplatelet agents is felt to be safe, whereas there are mixed recommendations for anticoagulants, as described further in Table 2.…”

“…Guidelines also suggest a target INR of anywhere from ≤1.5 to the most liberal suggestion of 2.0 to 3.0. [2][3][4] The SIR guidelines categorize LP as a low-bleeding risk procedure, with a platelet threshold of 20,000/µL but note that most other societies and guidelines regard LP as a high-bleeding risk procedure with more conservative platelet thresholds. 2 The Association of British Neurologists (ABN), however, allows platelets to be 40,000/µL or greater than 20,000/µL with an additional risk-benefit discussion.…”