Skip to main content

Advertisement

Log in

CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures

  • CIRSE Standards of Practice
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for peri-operative anticoagulation management during interventional radiology procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Keeling D, Tait RC, Watson H, British Committee of Standards for Haematology. Peri-operative management of anticoagulation and antiplatelet therapy. Br J Haematol. 2016;175:602–13.

    Article  Google Scholar 

  2. Gogarten W, Vandermeulen E, Van Aken H, Kozek S, Llau JV, Samama CM. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol. 2020. https://doi.org/10.1097/eja.0b013e32833f6f6f.

    Article  Google Scholar 

  3. Veitch AM, Baglin TP, Gershlick AH, Harnden SM, Tighe R, Cairns S. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut. 2008. https://doi.org/10.1136/gut.2007.142497.

    Article  PubMed  Google Scholar 

  4. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e326S–50S.

    Article  CAS  Google Scholar 

  5. Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727–36.

    Article  Google Scholar 

  6. Patel IJ, Rahim S, Davidson JC, Hanks SE, Tam AL, Gregory Walker T, et al. Society of interventional radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions—Part II: recommendations. J Vasc Interv Radiol. 2019. https://doi.org/10.1016/j.jvir.2019.04.017.

    Article  PubMed  Google Scholar 

  7. Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS Jr, Pohl D, et al. American college of surgeons’ guidelines for the perioperative management of antithrombotic medication. J Am Coll Surg. 2018;227(521–536):e1.

    Google Scholar 

  8. Kyaw Tun J, Khwaja S, Flanagan S, Fotheringham T, Low D. Current practice of periprocedural haematological management for patients undergoing image-guided procedures. Br J Radiol. 2015;88:20140778.

    Article  CAS  Google Scholar 

  9. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. Br J Haematol. 2008. https://doi.org/10.1111/j.1365-2141.2007.06968.x.

    Article  PubMed  Google Scholar 

  10. Segal JB, Dzik WH, Transfusion Medicine/Hemostasis Clinical Trials Network. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion. 2005;45:1413–25.

    Article  Google Scholar 

  11. ISTH SSC reference tools: International Society on Thrombosis and Haemostasis, Inc. https://www.isth.org/page/reference_tools. Accessed 23 Dec 2018.

  12. Lisman T, Porte RJ. Value of preoperative hemostasis testing in patients with liver disease for perioperative hemostatic management. Anesthesiology. 2017;126:338–44.

    Article  Google Scholar 

  13. Weeder PD, Porte RJ, Lisman T. Hemostasis in Liver Disease: implications of new concepts for perioperative management. Transfus Med Rev. 2014;28:107–13.

    Article  Google Scholar 

  14. Bonhomme F, Boehlen F, Clergue F, de Moerloose P. Preoperative hemostatic assessment: a new and simple bleeding questionnaire. Can J Anaesth. 2016;63:1007–15.

    Article  Google Scholar 

  15. Thomas W, Samama C-M, Greinacher A, Hunt BJ, Subcommittee on Perioperative and Critical Care. The utility of viscoelastic methods in the prevention and treatment of bleeding and hospital-associated venous thromboembolism in perioperative care: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16:2336–40.

    Article  CAS  Google Scholar 

  16. Resnick SB, Resnick SH, Weintraub JL, Kothary N. Heparin in interventional radiology: a therapy in evolution. Semin Intervent Radiol. 2005;22:95–107.

    Article  Google Scholar 

  17. Kumar P, Ravi R, Sundar G, Shiach C. Direct oral anticoagulants: an overview for the interventional radiologist. Cardiovasc Intervent Radiol. 2017;40:321–30.

    Article  Google Scholar 

  18. Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood. 2014;124:2450–8.

    Article  CAS  Google Scholar 

  19. Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012. https://doi.org/10.1182/blood-2012-06-415943.

    Article  PubMed  Google Scholar 

  20. Atwell TD, Wennberg PW, McMenomy BP, Murthy NS, Anderson JR, Kriegshauser JS, et al. Peri-procedural use of anticoagulants in radiology: an evidence-based review. Abdom Radiol (NY). 2017;42:1556–65.

    Article  Google Scholar 

  21. Ault MJ, Rosen BT, Scher J, Feinglass J, Barsuk JH. Thoracentesis outcomes: a 12-year experience. Thorax. 2015. https://doi.org/10.1136/thoraxjnl-2014-206114.

    Article  PubMed  Google Scholar 

  22. Crockett MT, Moynagh MR, Kavanagh EC. The novel oral anticoagulants: an update for the interventional radiologist. Am J Roentgenol. 2012. https://doi.org/10.2214/ajr.11.8151.

    Article  Google Scholar 

  23. Darcy MD, Kanterman RY, Kleinhoffer MA, Vesely TM, Picus D, Hicks ME, et al. Evaluation of coagulation tests as predictors of angiographic bleeding complications. Radiology. 1996. https://doi.org/10.1148/radiology.198.3.8628863.

    Article  PubMed  Google Scholar 

  24. Estcourt LJ, Desborough M, Hopewell S, Trivella M, Doree C, Stanworth S. Comparison of different platelet transfusion thresholds prior to insertion of central lines in patients with thrombocytopenia. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.cd011771.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Boyum JH, Atwell TD, Schmit GD, Poterucha JJ, Schleck CD, ScottHarmsen W, et al. Incidence and risk factors for adverse events related to image-guided liver biopsy. Mayo Clin Proc. 2016. https://doi.org/10.1016/j.mayocp.2015.11.015.

    Article  PubMed  Google Scholar 

  26. Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, et al. Guidelines for the use of platelet transfusions. Br J Haematol. 2017;176:365–94.

    Article  Google Scholar 

  27. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  Google Scholar 

  28. Bella PD, Della Bella P, Vergara P. Faculty of 1000 evaluation for A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. F1000: Post-publication peer review of the biomedical literature. 2014. https://doi.org/10.3410/f.718304415.793492097.

  29. Omran H, Bauersachs R, Rübenacker S, Goss F, Hammerstingl C. The HAS-BLED score predicts bleedings during bridging of chronic oral anticoagulation: results from the national multicentre BNK Online bRiDging REgistRy (BORDER). Thromb Haemost. 2012;108:65–73.

    Article  CAS  Google Scholar 

  30. Tafur AJ, McBane R 2nd, Wysokinski WE, Litin S, Daniels P, Slusser J, et al. Predictors of major bleeding in peri-procedural anticoagulation management. J Thromb Haemost. 2012;10:261–7.

    Article  CAS  Google Scholar 

  31. Daniels PR. Peri-procedural management of patients taking oral anticoagulants. BMJ. 2015;351:h2391.

    Article  Google Scholar 

  32. Clark NP, Douketis JD, Hasselblad V, Schulman S, Kindzelski AL, Ortel TL, et al. Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: analysis of the BRIDGE trial. Am Heart J. 2018;195:108–14.

    Article  Google Scholar 

  33. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823–33.

    Article  CAS  Google Scholar 

  34. Shahi V, Brinjikji W, Murad MH, Asirvatham SJ, Kallmes DF. Safety of uninterrupted warfarin therapy in patients undergoing cardiovascular endovascular procedures: a systematic review and meta-analysis. Radiology. 2016. https://doi.org/10.1148/radiol.2015142531.

    Article  PubMed  Google Scholar 

  35. Thomas S, Makris M. The reversal of anticoagulation in clinical practice. Clin Med. 2018;18:314–9.

    Article  Google Scholar 

  36. Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Guidelines on oral anticoagulation with warfarin. Br J Haematol. 2011;154:311–24.

    Article  Google Scholar 

  37. Hunt BJ, Allard S, Keeling D, Norfolk D, Stanworth SJ, Pendry K, et al. A practical guideline for the haematological management of major haemorrhage. Br J Haematol. 2015;170:788–803.

    Article  Google Scholar 

  38. Cuker A, Burnett A, Triller D, Crowther M, Ansell J, Van Cott EM, et al. Reversal of direct oral anticoagulants: guidance from the Anticoagulation Forum. Am J Hematol. 2019;94:697–709.

    Article  Google Scholar 

  39. Makris M, Van Veen JJ, Tait CR, Mumford AD, Laffan M, British Committee for Standards in Haematology. Guideline on the management of bleeding in patients on antithrombotic agents. Br J Haematol. 2013;160:35–46.

    Article  CAS  Google Scholar 

  40. Goldstein JN, Refaai MA, Milling TJ Jr, Lewis B, Goldberg-Alberts R, Hug BA, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet. 2015;385:2077–87.

    Article  CAS  Google Scholar 

  41. Milling TJ Jr, Refaai MA, Sarode R, Lewis B, Mangione A, Durn BL, et al. Safety of a four-factor prothrombin complex concentrate versus plasma for vitamin K antagonist reversal: an integrated analysis of two phase IIIb clinical trials. Acad Emerg Med. 2016;23:466–75.

    Article  Google Scholar 

  42. Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511–20.

    Article  CAS  Google Scholar 

  43. Hunt BJ, Levi M. Urgent reversal of vitamin K antagonists. BMJ. 2018;360:j5424.

    Article  Google Scholar 

  44. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054.

    Article  Google Scholar 

  45. CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376: 23–32.

  46. Heo Y-A. Andexanet Alfa: first global approval. Drugs. 2018;78:1049–55.

    Article  CAS  Google Scholar 

  47. Tran H, Joseph J, Young L, McRae S, Curnow J, Nandurkar H, et al. New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management. Internal Med J. 2014. https://doi.org/10.1111/imj.12448.

    Article  Google Scholar 

  48. Shi WG, Crowther M. North America anticoagulation forum guidance on reversal of direct oral anticoagulants. Eur J Intern Med. 2019;67:30–2.

    Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Raman Uberoi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hadi, M., Walker, C., Desborough, M. et al. CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures. Cardiovasc Intervent Radiol 44, 523–536 (2021). https://doi.org/10.1007/s00270-020-02763-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02763-4

Keywords

Navigation