Anticoagulation and Bleeding Risk
According to the Society of Interventional Radiology guidelines, the following thresholds are recommended for procedures with low bleeding risk (which includes most of our bedside procedures):
Platelet and INR Goals |
Anticoagulation Hold Time |
|---|---|
|
Paracentesis: Plt > 20K, INR < 4 (Fibrinogen > 120) Thoracentesis: Plt > 50K, INR < 2 (Fibrinogen > 150) Lumbar Puncture: Plt > 50K, INR < 1.6 (Fibrinogen > 150) Central Line: Plt > 20K, INR < 3 (Fibrinogen > 120) |
Heparin Infusion: 6 hours (normalized PTT) LMWH: 12-24 hours DOAC: 24-48 hours Warfarin: 5-7 days (normalized INR) Plavix: 5 days Resume... Heparin 2 hours post-procedure DVT prophylaxis 6 hours post-procedure DOAC with next dose due |
Always consider the relative bleeding risk of the procedure in the context of the patient and the clinical urgency for which the procedure is being done. Procedures like paracentesis, for example, are routinely performed on patients with increased risk of bleeding, so holding additional anticoagulants when reasonable helps modify any additional bleeding risk. When in doubt, check with your team pharmacist.