Anticoagulation and Bleeding Risk
Anticoagulant |
How long to hold |
|---|---|
| Heparin gtt | 4-8 hours, ensure PTT wnl |
| LMWH | 12-24 hours |
| Dabigatran (Pradaxa) | 1-2 days |
| Apixaban (Eliquis) | 1-2 days |
| Rivaroxaban (Xarelto) | 1-2 days |
| Warfarin (Coumadin) | 5-7 days |
According to the Society of Interventional Radiology guidelines, the following procedures are considered a low bleeding risk:
- Arterial access, peripheral and <6F sheath (A-lines)
- Dialysis access
- Lumbar puncture
- Paracentesis
- Thoracentesis
- Venous access (central line, PIV)
For these procedures, the following thresholds are recommended per their guidelines:
- INR corrected to range of <2-3 o Platelets >20
- Fibrinogen > 100 (if cirrhosis patient)
- Timing of holding anticoagulation for patients at high risk for bleeding as above. Note that for patients at low risk of bleeding, these agents do not necessarily need to be withheld (with the exception of ensuring INR <3 for patients on Warfarin). Consider using the HAS-BLED scoring system to risk stratify patient risk of bleeding.