Interventional Radiology Periprocedural Management of Anticoagulation and Antiplatelet Therapy
Low-Risk Procedures: E.g.
Biopsy and drainage – Superficial (breast, superficial bone, lymph node)
Bone marrow biopsy
Catheter exchanges (G Tubes, Biliary, Nephrostomy etc)
Angiogram using sheath <=6 French for diagnosis, embolization. Angioplasty and stenting are considered high-risk
Chest tube
Diagnostic venograms
Dialysis access interventions
Fine Needle aspirations (Lymph nodes, thyroids)
Joint injections including lumbar facet injections (Cervical facet injections are considered high-risk)
Nontunneled venous catheters
Paracentesis,
IVC filter placement
IVC filter removal – simple
Thoracentesis
Transjugular liver biopsy
Trigger point injections including piriformis
Tunneled venous catheter placement/removal (including ports)
Definition: Incidence of major bleeding is < 1.5%, 2-day risk of major bleeding of > 2%, bleeding is easy to diagnose and treat (e.g. bleed in peritoneal cavity, lung parenchyma, retroperitoneum) or if even minor amount of bleed can lead to devastating consequences (e.g. eye, spinal cord, brain).
High-Risk Procedures:
Ablations of bones, lung, soft tissue, solid organs
Abscess drainage of deep structures like lung, abdomen, pelvis, retroperitoneum
Angiograms needing > 7 F sheath
Angiograms needing interventions like stenting of aorta, CNS, extremity arteries, mesenteric arteries
Biliary interventions
Biopsy of intraabdominal, lung, pelvis, retroperitoneum, solid organs (liver, kidney etc), spine lesions
Catheter-directed thrombolysis
Cholecystostomy
Gastrostomy/Gastrojejunostomy
IVC filter removal – Complex
Portal vein interventions
Spine procedures – cervical facet injection, epidural injections, lumbar punctures, vertebroplasty
Transjugular intrahepatic portosystemic shunt
Urinary tract interventions – Nephrostomy, Ureteral dilatation, stone removal
Venous interventions needing venoplasty, stent placement
Definition: Incidence of major bleeding is > 1.5%, 2-day risk of major bleeding of 0-2%, bleeding is easy to diagnose and treat.
Thrombosis Risk Assessment for Interventional Radiology
Bleeding Risk Assesment for Interventional Radiology
Suggested Links, References:
Interventional Radiology Medications – Articl.net
Patel, Indravadan J., et al. “Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe.” Journal of vascular and interventional radiology: JVIR (2019).
Patel, Indravadan J., et al. “Addendum of newer anticoagulants to the SIR consensus guideline.” Journal of Vascular and Interventional Radiology 24.5 (2013): 641-645.
Jaffe, Tracy A., et al. “Management of anticoagulant and antiplatelet medications in adults undergoing percutaneous interventions.” American Journal of Roentgenology 205.2 (2015): 421-428.