FAQ - Radiologic Procedures
The 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 Periprocedural 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.