Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions

Jaffe, Tracy A.; Raiff, Doug; Ho, Lisa M.; Kim, Charles Y.

doi:10.2214/ajr.14.13342

Cited by 43 publications

(25 citation statements)

References 32 publications

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“…[ 5 6 7 8 9 10 11 ] The recommendations as to the length of withholding before procedure, and the appropriate time to restart the NOAC remain unclear and sometimes speculative. [ 5 7 8 9 10 11 ] Moreover, the impact of renal impairment, creatinine clearance, the different NOACs, and the risk categorization of procedures remain conflicted. [ 7 8 9 10 11 ] Nevertheless, Ema at el.…”

Section: Discussionmentioning

confidence: 99%

Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma

et al. 2020

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Page kidney was described by Page, following very elaborate experiments with animal kidneys in 1939, with persistent arterial hypertension from “cellophane perinephritis.” Subsequently, it was reported after trauma, from renal cysts and tumors, and from intrarenal hematoma complicating percutaneous kidney biopsy. We describe Page kidney associated with acute kidney injury 26 days after an uncomplicated ultrasound-guided right native kidney biopsy. Patient was on Apixaban, a non-vitamin K antagonist oral anticoagulant (NOAC) for atrial fibrillation which was withheld 3 days before the procedure. It was restarted 3 days after. The evidence-base supporting guidelines and recommendations for the peri-procedural management of the NOACs is inadequate, sparse, and often conflicted. More research is warranted.

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Section: Discussionmentioning

confidence: 99%

Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma

et al. 2020

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“…In the present study, one patient with chronic renal failure developed hemorrhagic complications. If the patient is taking an anticoagulant or antithrombotic, stopping the medication for 3 -10 days is recommended before and after US-FNA (4,5,9,11,17,18). However, performing US-FNA in patients taking anticoagulant or antithrombotic remains controversial and lacking in evidence, such as randomized controlled study (2,4,7,9,16,33).…”

Section: Discussionmentioning

confidence: 99%

Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

et al. 2018

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Background: Thyroid nodules are a common clinical problem and ultrasound-guided fine needle aspiration (US-FNA) biopsy is widely used for evaluation of thyroid nodules. However, few studies have addressed the contributing factors to hemorrhage after US-FNA of thyroid nodules. Objectives: To assess the contributory factors related to patient characteristics, ultrasound (US) features of the thyroid nodules, and the US-FNA procedures to affect hemorrhage complications after US-FNA of thyroid nodules. Methods: Between March 2014 and April 2015, 366 consecutive patients who underwent US-FNA of thyroid nodules were enrolled in this retrospective study. The characteristics of hematomas, including the location, maximum size, and clinical course, were assessed. The relationships between hematomas and factors related to the medical characteristics of patients, US characteristics of the nodules, and FNA procedural factors were analyzed. Results: Data on 365 nodules in 321 patients who underwent US-FNA of thyroid nodules were analyzed. Minor hemorrhagic complications developed in 14 (3.8%) of the 365 nodules. There were no statistically significant differences between patients taking or not taking an anticoagulant or antithrombotic (P = 0.270). Factors related to increased risk of hematoma were male sex (P = 0.031), larger maximum size (P = 0.002), a cystic or predominantly cystic nodule (P < 0.0001), a probable benign nodule (P < 0.0001), thicker needle size (P < 0.0001), and a greater number of the needle passes (P = 0.005). Conclusions: US-FNA can be performed safely even in patients taking anticoagulant or antithrombotic agents. Factors related to hemorrhagic complications are male sex, larger nodules, cystic or predominantly cystic nodules, probably benign nodules, thicker needles and a greater number of needle passes.

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“…For patients who cannot be off anticoagulation therapy, heparin bridge therapy may be planned by the clinical team. Low-dose or high-dose acetylsalicylic acid (aspirin) treatment does not need to be blocked while clopidogrel may be discontinued some days before and resumed immediately after the procedure [90]. Specific recommendations are in use for newer anticoagulant drugs.…”

Section: Bleeding Disorders and Antiplatelet And Anticoagulation Thermentioning

confidence: 99%

Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

et al. 2020

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We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as "high-risk" or B3 lesions). Finally, seven frequently asked questions are answered.

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Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions

Abstract: To improve patient safety, radiologists involved in percutaneous procedures should have knowledge of the antithrombotics that will be encountered routinely in clinical practice.

Cited by 43 publications

References 32 publications

Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma

Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma

Contributory Factors to Hemorrhage After Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules with an Emphasis on Patients Taking Antithrombotic or Anticoagulant Medications

Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

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