Last updated March 14, 2022

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

 New Recommendations

• 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.

Updated Recommendations

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.

Unchanged Recommendations

• Routine screening coagulation laboratory testing (prothrombin time/INR, platelet count, hemoglobin) not recommended for procedures with low bleeding risk.
• Routine screening coagulation laboratory testing (prothrombin time/INR, platelet count, hemoglobin) recommended for procedures with high bleeding risk.
• Recommended minimum platelet threshold of 50 × 109/L for high bleeding risk procedures.

Recommendation Grading

Overview

Title

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

Authoring Organization

Publication Month/Year

June 19, 2020

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

Part II of the consensus guidelines updates the recommendations for the periprocedural management of thrombotic and bleeding risks in patients who require image-guided interventions. 

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Hospital, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D006470 - Hemorrhage, D013927 - Thrombosis

Keywords

DAPT, Percutaneous Image-Guided Interventions, bleeding risk

Source Citation

Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol [Internet]. 2012;23(6):727–36. Available from: http://dx.doi.org/10.1016/j.jvir.2012.02.012