Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions

• Bleeding and thrombotic risks of each patient are dependent on medical comorbidities and need to be considered as part of periprocedural management.
• For high-risk or complex cases, a multidisciplinary, shared decision-making process is encouraged for periprocedural management recommendations to optimize patient outcomes.
• Algorithms are incorporated to provide a framework to guide the periprocedural management of patients who are receiving anticoagulation and/or antiplatelet agents.
• Laboratory parameters specific to patients with chronic liver disease have been suggested predicated on the concept of rebalanced primary and secondary hemostasis in this patient population.
• Procedure-associated bleeding risks for image-guided interventions have been reclassified into low risk versus high risk for major bleeding.
• Recommendations for timing of postprocedural reinitiation of anticoagulant or antiplatelet medications have been added.

Revision of laboratory parameter recommendations:

a. No data to support activated partial thromboplastin time recommendations. Recommendations removed.
b. Recommended minimum platelet threshold of 20 × 10⁹/L for low bleeding risk procedures.
c. Recommended correction of International Normalized Ratio (INR) to within range of 2.0–3.0 or less for low bleeding risk procedures. If arterial access is required, correction of INR to <1.8 for femoral access and <2.2 for radial access.
d. Recommended correction of INR to within range of 1.5–1.8 or less for high bleeding risk procedures.