Correction of Coagulopathy for Percutaneous Interventions

Wiltrout, Charles; Kondo, Kimi L.

doi:10.1055/s-0030-1267857

Cited by 6 publications

(5 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients undergoing percutaneous intervention often have abnormal hemostasis due to existing disease or pharmacotherapy (10).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The risk of bleeding complications on percutaneous biliary drainage in patients with abnormal hemostasis

Gündoğdu

2022

Anatolian Current Medical Journal

View full text Add to dashboard Cite

Aim: To determine whether the risk of bleeding complications in percutaneous biliary drainage is higher in adults whose hemostasis cannot be corrected before the procedure than in those whose hemostasis is corrected. Material and Method: 62 patients who underwent percutaneous biliary drainage were included in the study. Patients with abnormal hemostasis were divided into those with corrected hemostasis (group I) and uncorrected hemostasis (group II). The groups were evaluated for the presence of bleeding complications by ultrasonography, computed tomography and laboratory findings. The groups were compared in terms of age, gender, side, drainage type, and bleeding complications. Results: Of the 62 patients included in the study, 52% (n:32) were female and 48% (n:30) were male, with a mean age of 67.6±9.6 (48-90). Age and female sex ratio were higher in Group II, which was statistically significant (p<0.001, p:0.014). There was no statistically significant difference between the groups in terms of side. Internal drainage was applied to patients in group II at a higher rate than group I. There was a statistically significant difference between the groups in terms of drainage type (p:0.002). There were bleeding complications in 19.3% (n:12) of the patients. Bleeding rate was higher in group II (31.8%) compared to group I (12.5%), and there was no statistically significant difference between the groups (p:0.094). None of the patients required surgical treatment due to bleeding and mortality did not occur. Conclusion:In patients with abnormal hemostasis requiring percutaneous biliary drainage, the rate of bleeding complications was higher in patients whose hemostasis was not corrected than in those with corrected hemostasis.

show abstract

“…Patients undergoing percutaneous intervention often have abnormal hemostasis due to existing disease or pharmacotherapy (10).…”

Section: Discussionmentioning

confidence: 99%

“…According to these variables, there may be more than one option to correct the coagulation defect. Before the procedure, hemostasis can be corrected or improved with platelet suspension, fresh frozen plasma (ffp), and/or vitamin K (10).…”

Section: Introductionmentioning

confidence: 99%

The risk of bleeding complications on percutaneous biliary drainage in patients with abnormal hemostasis

Gündoğdu

2022

Anatolian Current Medical Journal

View full text Add to dashboard Cite

show abstract

“…Amongst the current opinion piece, consensus guideline, and review articles, authors concluded correction of coagulation abnormalities prior to thoracentesis is either unnecessary or a clinical question requiring further research. [2][3][4][5][6][7][8][9][10] The Puchalski et al prospective observational cohort study evaluated 312 patients who underwent thoracentesis categorized by bleeding risk. Those with increased bleeding risk (42%) had no difference in post-procedural hematocrit or bleeding events compared with patients who had normal bleeding risk.…”

Section: Related Literaturementioning

confidence: 99%

Correction of abnormal coagulation parameters as prophylaxis for post-procedural bleeding is unnecessary prior to ultrasound-guided thoracentesis

Walton

2018

Clin. Res. Pract.

View full text Add to dashboard Cite

show abstract

“…Administration of PCC or fresh frozen plasma is associated with high risk and has been considered inappropriate to normalize coagulation before neuraxial procedures (640)(641)(642)(643)(644)(645)(646)(647)(648)(649)(650)(651)(652)(653)(654)(655)(656). Vitamin K supplementation may be considered in some patients .…”

Section: Vitamin K Antagonistsmentioning

confidence: 99%

Assessment of Bleeding Risk of Interventional Techniques: A Best Evidence Synthesis of Practice Patterns and Perioperative Management of Anticoagulant and Antithrombotic Therapy

Atlantic

Manchikanti

Benyamin³

et al. 2013

Pain Phys

View full text Add to dashboard Cite

Background: Interventional pain management is a specialty that utilizes invasive procedures to diagnose and treat chronic pain. Patients undergoing these treatments may be receiving exogenous anticoagulants and antithrombotics. Even though the risk of major bleeding is very small, the consequences can be catastrophic. However, the role of antithrombotic therapy for primary and secondary prevention of cardiovascular disease to decrease the incidence of acute cerebral and cardiovascular events is also crucial. Overall, there is a paucity of literature on the subject of bleeding risk in interventional pain management along with practice patterns and perioperative management of anticoagulant and anti-thrombotic therapy. Study Design: Best evidence synthesis. Objective: To critically appraise and synthesize the literature with assessment of the bleeding risk of interventional techniques including practice patterns and perioperative management of anticoagulant and antithrombotic therapy. Methods: The available literature on the bleeding risk of interventional techniques and practice patterns and perioperative management of anticoagulant and antithrombotic therapy was reviewed. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 through December 2012 and manual searches of the bibliographies of known primary and review articles. Results: There is good evidence for the risk of thromboembolic phenomenon in patients who discontinue antithrombotic therapy, spontaneous epidural hematomas occur with or without traumatic injury in patients with or without anticoagulant therapy associated with stressors such as chiropractic manipulation, diving, and anatomic abnormalities such as ankylosing spondylitis, and the lack of necessity of discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin prior to performing interventional techniques. There is fair evidence that excessive bleeding, including epidural hematoma formation may occur with interventional techniques when antithrombotic therapy is continued, the risk of thromboembolic phenomenon is higher than the risk of epidural hematomas with discontinuation of antiplatelet therapy prior to interventional techniques, to continue phosphodiesterase inhibitors (dipyridamole [Persantine], cilostazol [Pletal], and Aggrenox [aspirin and dipyridamole]), and that anatomic conditions such as spondylosis, ankylosing spondylitis and spinal stenosis, and procedures involving the cervical spine; multiple attempts; and large bore needles increase the risk of epidural hematoma; and rapid assessment and surgical or nonsurgical intervention to manage patients with epidural hematoma can avoid permanent neurological complications. There is limited evidence to discontinue antiplatelet therapy with platelet aggregation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy clopidogrel (Plavix), ticlopidine (Ticlid), or prasugrel (Effient) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa®) and rivaroxaban (Xarelto®) to discontinue to avoid bleeding and epidural hematomas during interventional techniques and to continue to avoid cerebrovascular and cardiovascular thromboembolic events. Recommendations: The recommendations derived from the comprehensive assessment of the literature and guidelines are to continue NSAIDs and low dose aspirin, and phosphodiesterase inhibitors (dipyridamole, cilostazol, Aggrenox) during interventional techniques. However, the recommendations for discontinuation of antiplatelet therapy with platelet aggregation inhibitors (clopidogrel, ticlopidine, prasugrel) is variable with clinical judgment to continue or discontinue based on the patient’s condition, the planned procedure, risk factors, and desires, and the cardiologist’s opinion. Low molecular weight heparin (LMWH) or unfractionated heparin may be discontinued 12 hours prior to performing interventional techniques. Warfarin should be discontinued or international normalized ratio (INR) be normalized to 1.4 or less for high risk procedures and 2 or less for low risk procedures based on risk factors. It is also recommended to discontinue Pradaxa for 24 hours for paravertebral interventional techniques in 2 to 4 days for epidural interventions in patients with normal renal function and for longer periods of time in patients with renal impairment, and to discontinue rivaroxaban for 24 hours prior to performing interventional techniques. Limitations: The paucity of the literature. Conclusion: Based on the available literature including guidelines, the recommendations in patients with antithrombotic therapy for therapy prior to interventional techniques are provided. Key words: Perioperative bleeding, bleeding risk, practice patterns, anticoagulant therapy, antithrombotic therapy, interventional techniques, safety precautions

show abstract

Correction of Coagulopathy for Percutaneous Interventions

Cited by 6 publications

References 46 publications

The risk of bleeding complications on percutaneous biliary drainage in patients with abnormal hemostasis

The risk of bleeding complications on percutaneous biliary drainage in patients with abnormal hemostasis

Correction of abnormal coagulation parameters as prophylaxis for post-procedural bleeding is unnecessary prior to ultrasound-guided thoracentesis

Assessment of Bleeding Risk of Interventional Techniques: A Best Evidence Synthesis of Practice Patterns and Perioperative Management of Anticoagulant and Antithrombotic Therapy

Contact Info

Product

Resources

About