Frequently Asked Questions

Radiologic Procedure Issues

1	Which medications should be discontinued prior to an invasive radiologic procedure?
2	Which procedures require that patients have coagulation studies drawn prior to the procedure? Coagulation labs include platelets, PT/INR. (PTT is no longer required for pre-procedural evaluation).
3	What coagulation cutoff parameters do you use for invasive radiological prodedures?
4	What are the guidelines regarding barium enemas following incomplete colonoscopies?
5	What formulations do you use for intra-articular steroid injections?

Which medications should be discontinued prior to an invasive radiologic procedure?

• Patients should stop taking Coumadin 5 days prior to any such procedure. For all such patients on Coumadin, coagulation studies should then be ordered on the day of procedure, including a PT/INR.

• EXCEPTION: Patients scheduled for arthrograms may continue their Coumadin regimen, but the procedure will be rescheduled or cancelled if their INR level is above 3.5.

• Low molecular weight heparin should not be administered less than 24 hours prior to the procedure.

• For core biopsies only, patients should also stop the following 5 days prior: aspirin, non-steroidal anti-inflammatory drugs (NSAID’s), Plavix, garlic pills, and gingko supplements. Thyroid fine needle aspirations and all non-biopsy procedures are exempt from this last condition.

Which procedures require that patients have coagulation studies drawn prior to the procedure? Coagulation labs include platelets, PT/INR. (PTT is no longer required for pre-procedural evaluation).

Angiograms
Angioplasty
Arteriovenous fistulogram
Biliary drain
Biopsies
Central line placement (permanent or temporary)
Cholangiograms (percutaneous)
Cryoplasty
Dialysis catheter placement (permanent or temporary)
Drains and chest tubes
Embolization and chemo-embolization
Epidural steroid injection
IVC filters
Kyphoplasty
Lumbar puncture
Myelogram
Nephrostomy
Nerve root block
Paracentesis
PICC placement
Pyelogram (antegrade)
Radiofrequency ablation
Thoracentesis
Ureteral stents
Vascular stents and stent grafts
Venograms
Vertebroplasty

Note: Coagulation studies are only required for arthograms, including sacroiliac joint injections, if the patient is on anticoagulants.

What coagulation cutoff parameters do you use for invasive radiological prodedures?

In general, platelets greater than 100, PT/INR of less than 1.5 are needed to proceed with an invasive procedure. Of note; PTT is no longer needed to be checked. These parameters may be modified on a case by case basis at the radiologist's discretion.

What are the guidelines regarding barium enemas following incomplete colonoscopies?

• For barium enemas ordered following an incomplete colonoscopy, the patient should have the enema scheduled at 7-10 days after colonoscopy if any biopsy, polypectomy, fulguration, or laser coagulation has been performed during the colonoscopy.

• Otherwise, an attempt will be made to perform the barium the same day of the colonoscopy. Of note, enemas may be too difficult to perform in some patients with excessive retained gas after colonoscopy. The patients may be requested to return on the following day for the barium enema.

• Personal communication, University of WA gastrointestinal imaging staff

What formulations do you use for intra-articular steroid injections?

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