RUH Guidelines for management of patients on anticoagulants or anti-platelet agents undergoing Radiology procedures with low risk of bleeding

LOW RISK BLEEDING Clopidogrel/ Prasugrel

Ticagrelor/ Dabigatran
Dipyridamole LMWH NSAIDS Aspirin Rivaroxaban/ Apixaban

Warfarin
Continue if used alone. Therapeutic dose: LOWER RISK THROMBOSIS HIGHER RISK
If used in combination Withhold 24hrs before Ischaemic heart disease THROMBOSIS
with aspirin, stop Continue Email Haematology: without coronary stent Coronary artery stents
dipyridamole the day Prophylactic dose: (include type & date of procedure):
Cerebrovascular disease Stroke/TIA or venous
before biopsy. Withhold 12hrs before thrombosis within last 3
Peripheral vascular disease
ruh-tr.AnticoagulationTeam@nhs.net months
Prevention of recurrent
Cerebrovascular stents
DVT/PE (after 6months Tx) Treatment of DVT or PE

Low Risk Bleeding: Tests & Thresholds:

STOP Clopidogrel & Prasugrel STOP Liaise with
Non-tunnelled venous catheter INR - recommended (within 7 7 days pre-procedure Cardiology/
Dialysis access interventions days of procedure) Haematology
Central line removal Continue aspirin if on dual antiplatelets
APTT - recommended (correct Substitute aspirin if on single agent Consider stopping
IVC filter placement
so value 1.5x control) Clopidogrel/ Prasugrel
Venography STOP Dabigatran/Rivaroxaban/Apixaban/ 7 days before
Catheter exchange (biliary/ nephrostomy/ Platelet count - Not routinely Ticagrelor only on morning of procedure procedure if::
abscess drainage catheter) recommended >12 months after
Thoracocentesis insertion of drug-
Paracentesis eluting coronary stent
>1 month after
Thyroid biopsy
Non severe thrombophilia eg heterozygous insertion of bare metal
Superficial aspiration, drainage and/or biopsy for factor V Leiden or heterozygous for coronary stent
(excluding intra-thoracic or intra-abdominal prothrombin G20210A mutation
sites)
GI tract dilatation Severe thrombophilia eg deficiency of protein
FNA/Joint Aspiration/injection continue C, protein S or antithrombin, antiphosholipid
warfarin (no INR required), aspirin, LMWH syndrome or multiple/homozygous abnormalities
(therapeutic dose), clopidogrel and
dabigatran

References
1. Patel IJ, Davidson JC, Nikolic B et al. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol 2013;24:641-5.
2. Foremny GB, Pretell-Mazzini J, Jose J et al. Risk of bleeding associated with interventional musculoskeletal radiology procedures. A comprehensive review of the literature. Skeletal Radiol 2015;44:619-27.
3. RUH Trust Haematology Guidelines (2016) Peri-operative management of antiplatelet agents.
4. RUH Trust Haematology Guidelines (2014) Warfarin peri-procedural management of anticoagulation.
Ref.: RAD-012-Management of Low Risk Patients on Anticoagulants or Anti-platelets undergoing Radiology Version: 2.0
Procedures
Approved by: Consultant Radiologists @ Consultant Meeting Dr A.Phillips & Dr J Crowe Consultant Haematologist Approved on: 22 November 2016
Author: Dr G Stenhouse Consultant Radiologist Review date: 22 November 2019
Date of Issue: 24 November 2016 Page 1 of 1
Royal United Hospitals Bath NHS Foundation Trust