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
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
- 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
Frequently Asked Questions
What are the coagulation guidelines for paracentesis?
For paracentesis, no lab values are needed if the patient is not on Coumadin. However, if the patient is on Coumadin, platelets should be greater than 25,000, and INR should be less than 2.0 to proceed with the procedure safely. These guidelines ensure that the patient's blood clotting ability is adequate to prevent excessive bleeding.
When should anticoagulant medications be stopped before IR procedures?
For IR procedures, Coumadin and Plavix should be stopped 5 days prior. The evening dose of low molecular weight heparin (LMWH) should be held, but there is no change needed for ASA (aspirin). These precautions help reduce the risk of bleeding during and after the procedure.
What lab values are required for thoracentesis?
For thoracentesis, it's important that the patient's platelets are greater than 50,000 and the INR is less than 1.5. These thresholds help ensure that the patient has a normal blood clotting function, reducing the risk of bleeding complications during the procedure.
How do coagulation guidelines differ for tunneled catheter placements?
Coagulation guidelines for tunneled catheter placements vary based on the catheter's caliber. For small caliber (5Fr and 6Fr) catheters, no specific lab values are needed. However, for large caliber catheters, platelets should be greater than 25,000 and INR should be less than 2.0. This distinction helps tailor the approach based on the invasiveness of the procedure.
What are the medication guidelines for patients on Coumadin undergoing IR procedures?
Patients on Coumadin should stop the medication 5 days before undergoing any IR procedures to minimize bleeding risks. If necessary, Coumadin can be converted to a shorter-acting anticoagulant. This allows the patient's INR to decrease to a safer level before the procedure.
Why are platelet and INR levels important for IR procedures?
Platelet count and INR are critical in assessing a patient's blood clotting ability. Platelets help with blood clot formation, while INR measures the time it takes for blood to clot. Ensuring these values are within specified ranges reduces the risk of bleeding during invasive procedures.
What coagulation guidelines are there for liver biopsies?
For transjugular liver biopsy, platelets should be greater than 25,000, and INR should be less than 2.0. These guidelines ensure that the blood's ability to clot is sufficient to handle the invasiveness of the procedure without leading to bleeding complications.
What are the coagulation considerations for embolization procedures?
For embolization procedures like UFE, DEB TACE, or Y90, platelets should be greater than 50,000, and INR should be less than 1.5. These guidelines help maintain hemostatic control, reducing potential bleeding during the manipulation of blood vessels.
How should anticoagulants be managed for patients undergoing a TIPS procedure?
Patients undergoing a TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure should have platelets greater than 50,000 and INR less than 1.5. Additionally, Coumadin, Plavix, and aspirin should be stopped 5 days prior to minimize bleeding risks during this complex procedure.