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coagulation guidelines for IR and CT invasive procedures

For the following procedures, NO lab values are needed

Paracentesis, if patient is NOT on Coumadin
Superficial aspiration/abscess//biopsy
IVC filter Placement
Tube check/change (biliary/nephrostomy/G or GJ tubes)
Vascath placement
Central line placement
Peripheral PICC placement
Tunneled (cuffed or non-cuffed) line exchange or removal
Tunneled small caliber (5Fr and 6Fr) central catheters (tunneled PICC) placement

For the following procedures, platelets should be > 50,000 and INR < 1.5

Thoracentesis
Port placement
Transarterial/venous

Arterial PTA/Stent / Venous PTA/Stent
AV fistula/revision
Embolization procedures (UFE/DEB TACE/Y90)
TIPS placement/revision

Solid Organ and Enteric Interventions

“Fresh Stick” biliary/nephrostomy/cholecystostomy tubes
G tube placement/GJ tube placement
Intrathoracic and intraabdominal Biopsy/Drainage/Cholecystostomy tubes
RFA/Cryoablation/Microwave ablation

Pain Management Procedures

Vertebroplasty/kyphoplasty
Nerve block/Epidural Steroid Injection

For the following procedures, platelets should be > 25,000 and INR <2.0

Tunneled large caliber catheter placement
Transjugular liver biopsy
Paracentesis, if patient is on Coumadin

For the following procedures, platelets should be > 25,000 and INR < 3.5

IVC filter retrieval
DVT Thrombolysis

Medications Guidelines Short Form— Haparin/Coumadin/Plavix/Lovenox/ASA/Baby ASA

1. IV heparin to stop 2 hours prior to IR procedures
2. NO change in subcutaneous heparin
3. NO change in any oral medications

  • Tube check/change (biliary/neph/G or GJ tubes)
  • Vascath placement
  • Central line placement
  • Peripheral PICC placement
  • Tunneled (cuffed or non-cuffed) line exchange or removal
  • Tunneled small caliber (5Fr and 6Fr) central catheters (tunneled PICC) placement
  • IVC Filter placement and removal
  • DVT thrombolysis
  • Paracentesis
  • Superficial aspiration/abscess//biopsy

4. Stop (Convert if indicated) Coumadin for 5 days prior to IR procedures, Hold evening dose of LMWH
or hold for 12 hours. NO change in other medications

  • Any arterial procedures (UFE/DEB TACE/Y90)
  • Any venous procedures
  • Tunneled large caliber catheter placement
  • Transjugular liver biopsy

5. Stop (Convert if indicated) Coumadin and Plavix for 5 days prior to IR procedures, Hold evening dose of LMWH,NO change in ASA

  • Port Placement
  • Lung/Liver/Intrathoracic/Intraabdominal abscess
  • De novo G tube placements
  • Epidural Steroid Injection/Vertebroplasty/Kyphoplasty

6. Stop (Convert if indicated) Coumadin, Plavix, ASA and Baby ASA for 5 days prior to IR procedures, Hold evening dose of LMWH.

  • TIPS
  • Renal Biopsy
  • Elective de novo Biliary/Nephrostomy
  • RFA/Cryoablation/Microwave ablation
  • Lung/Liver/Intrathoracic/Intraabdominal biopsy
  • Thoracentesis

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