FAQ-Radiologic Procedures

Information below is intended only as general guidelines for imaging guided procedures. On a case-by-case basis, radiology providers can alter the lab and medication suggestions based on individual assessment of patient risk versus benefit.

EXCEPTION: procedures below in bold italics do not require same day Hct draw.

Category 1

Low Bleeding Risk, Easy to Detect & Control

Category 2

Moderate Risk of Bleeding

Category 3

Significant Bleeding Risk, Hard to Detect & Control

General procedures Superficial biopsy (breast, lymph node) Abdominal/retroperitoneal biopsy or aspiration (except liver, spleen, and kidneys) Liver, spleen, kidney biopsy
Superficial FNA (thyroid, lymph node) Lung/chest wall biopsy
Superficial cyst aspiration Abscess drainage
Joint aspiration/injection Lumbar puncture, myelography
Thoracentesis
Paracentesis
Interventional radiology procedures Central line removal Angiography, arterial interventions (access size up to 7 French) Nephrostomy placement
Non tunneled central venous catheter placement Tunneled central venous catheter placement Biliary interventions (new tract)
Catheter exchange Subcutaneous port placement Radiofrequency ablation
Venography Venous interventions
IVC filter placement Chemo-embolization
Dialysis access intervention Uterine fibroid embolization
Transjugular liver biopsy
Cholecystostomy
Gastrostomy placement
Vertebroplasty

Lab draw guidelines

Lab draw guidelines

Category 1

Low Bleeding Risk, Easy to Detect & Control

Category 2

Moderate Risk of Bleeding

Category 3

Significant Bleeding Risk, Hard to Detect & Control

PT & INR Draw within 30 days for outpatients with liver disease.

Draw within 2 days for pts stopping Coumadin.

Otherwise not needed.

Draw within 30 days for scheduled outpatients.

Draw within 2 days for pts stopping Coumadin.

Draw during same presentation for ED & inpatients.

Draw within 5 days for scheduled outpatients.

Draw within 2 days for pts stopping Coumadin.

Draw during same presentation for ED & inpatients.

PTT No, except if pt on IV unfractionated heparin No, except if pt on IV unfractionated heparin No, except if pt on IV unfractionated heparin
Platelets Not routinely needed Recommended on all Recommended on all
Hematocrit Not routinely needed Draw on day of procedure Draw on day of procedure

Lab value thresholds

Lab value thresholds

Category 1

Low Bleeding Risk, Easy to Detect & Control

Category 2

Moderate Risk of Bleeding

Category 3

Significant Bleeding Risk, Hard to Detect & Control

INR >2.0: need to correct >1.5: need to correct >1.5: need to correct
PTT No consensus >1.5x control: correct >1.5x control: correct
Platelets Not applicable <50K: transfusion needed <50K: transfusion needed
Hematocrit Not applicable No threshold No threshold
Post procedure instructions Outpatients: may discharge home.

Inpatients: may return to hospital room.

Outpatients: Observe up to 1-2 hours before discharge.

Inpatients: monitor vitals up to 1-2 hours closely.

Outpatients: Observe at least 1-2h before discharge.

Inpatients: monitor vitals at least 1-2 hours closely.

Anticoagulation med instructions

Anticoagulation med instructions

Category 1

Low Bleeding Risk, Easy to Detect & Control

Category 2

Moderate Risk of Bleeding

Category 3

Significant Bleeding Risk, Hard to Detect & Control

Aspirin (low dose)

PO

No need to stop before.

Resume immediately after.

No need to stop before.

Resume immediately after.

No need to stop before.

Resume immediately after.

Aspirin (high dose)

PO

No need to stop before.

Resume immediately after.

Stop 0-5 days before.

Resume immediately after.

Stop 5 days before.

Resume immediately after.

Aspirin & dipyridamole (Aggrenox) PO Stop 2 days before.

Resume immediately after.

Stop 5 days before.

Resume immediately after.

Stop 5 days before.

Resume immediately after.

NSAID’s, short half-life:

Ibuprofen

Diclofenac

Ketoprofen

Indomethacin

No need to stop before.

Resume immediately after.

Stop 0-24 hours before.

Resume immediately after.

Stop 24 hours before.

Resume immediately after.

NSAID’s, intermed half-life:

Naproxen

Sulindac

Diflusinal

Celecoxib

Stop 24 hours before.

Resume immediately after.

Stop 0-48 hours before.

Resume immediately after.

Stop 72 hours before.

Resume immediately after.

NSAID’s, long half-life:

Meloxicam

Nabumetone

Piroxicam

Stop 24 hours before.

Resume immediately after.

Stop 0-48 hours before.

Resume immediately after.

Stop 3-10 days before.

Resume immediately after.

Warfarin (Coumadin) Stop 3-5 days before.

Resume 12 hours after.

Stop 5 days before.

Resume 12 hours after.

Stop 5 days before.

Resume 12-24 hours after.

Heparin (IV unfractionated) Stop 1 hour before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Heparin (SQ unfractionated) Stop 4 hours before.

Resume immediately after.

Stop 4 hours before.

Resume immediately after.

Stop 6 hours before.

Resume 1 hour after.

Enoxaparin (Lovenox)

SQ

Stop 12 hours before.

Resume 6 hours after.

Stop 12 hours before.

Resume 6 hours after.

Stop 24 hours before.

Resume 6 hours after.

Dalteparin (Fragmin)

SQ

Stop 12 hours before.

Resume 6 hours after.

Stop 12 hours before.

Resume 6 hours after.

Stop 24 hours before.

Resume 6 hours after.

Tinzaparin (Innohep)

SQ

Stop 12 hours before.

Resume 6 hours after.

Stop 12 hours before.

Resume 6 hours after.

Stop 24 hours before.

Resume 6 hours after.

Dabigatran (Pradaxa)

PO

Stop 0-48 hours before.

Resume 24 hours after.

Stop 72 hours before.

Resume 24 hours after.

Stop 72 hours before.

Resume 48 hours after.

Rivaroxaban (Xarelto)

PO

Stop 24 hours before.

Resume 24 hours after.

Stop 48 hours before.

Resume 48 hours after.

Stop 48 hours before.

Resume 48 hours after.

Apixaban (Eliquis)

PO

Stop 24 hours before.

Resume 24 hours after.

Stop 48 hours before.

Resume 48 hours after.

Stop 48 hours before.

Resume 48 hours after.

Fondaparinux (Arixtra)

SQ

Stop 24 hours before.

Resume 6 hours after.

Stop 72 hours before.

Resume 6 hours after.

Stop 72 hours before.

Resume 6 hours after.

Argatroban (Aggrastat)

IV

No need to stop before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Desirudin (Iprivask)

SQ

No need to stop before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Bivalirudin (Angiomax)

IV

No need to stop before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Stop 4 hours before.

Resume 1 hour after.

Cilostazol (Pletal)

PO

No need to stop before.

Resume immediately after.

No need to stop before.

Resume immediately after.

Stop 24 hours before.

Resume immediately after.

Clopidogrel (Plavix)

PO

Stop 0-5 days before.

Resume immediately after.

Stop 5 days before.

Resume immediately after.

Stop 5 days before.

Resume immediately after.

Prasugrel (Effient)

PO

Stop 5 days before.

Resume 24 hours after.

Stop 7 days before.

Resume 24 hours after.

Stop 7 days before.

Resume 24 hours after.

Ticagrelor (Brilinta)

PO

Stop 5 days before.

Resume 24 hours after.

Stop 7 days before.

Resume 24 hours after.

Stop 7 days before.

Resume 24 hours after.

Tirofiban (Aggrastat)

IV

Stop immediately before.

Resume 4 hours after.

Stop 4 hours before.

Resume 4 hours after.

Stop 4 hours before.

Resume 4 hours after.

Eptifibatide (Integrilin)

IV

Stop immediately before.

Resume 4 hours after.

Stop 4 hours before.

Resume 6 hours after.

Stop 4 hours before.

Resume 8 hours after.

Abciximab (ReoPro)

IV

Stop 12-24 hours before.

Check PTT for 50 s or less; ACT for 150 s or less.

Resume 4 hours after.

Stop 24 hours before.

Check PTT for 50 s or less; ACT for 150 s or less.

Resume 6 hours after.

Stop 24 hours before.

Check PTT for 50 s or less; ACT for 150 s or less.

Resume 8 hours after.

Sources:

Patel et al. Consensus Guidelines for Perprocedural Management of Coagulation Status and Hemostasis Risk in Percutaneous Image-guided Interventions. JVIR 2012; 23: 727-736.

Patel et al. Addendum of New Anticoagulants to the SIR Consensus Guideline. JVIR 2013; 24: 641-645.
Crockett et al. The Novel Oral Anticoagulants: An Update for the Interventional Radiologist. AJR 2012; 199: W376-379.

Jaffe et al. Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions. AJR 2015; 205: 421-428.

Copyright 2018 Skagit Radiology, Inc. P.S. All Rights Reserved.

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