Management of Anticoagulation and Antiplatelet Medication in Adults Undergoing Percutaneous Interventions

The Patients should be first assessed by taking bleeding history. Excessive coagulation testing before an elective IR procedure does not prevent postoperative bleeding and is not advised. If the history of structural bleeding is negative and the patient is not receiving antithrombotic therapy, then no coagulation test is needed. If the structured bleeding history is positive, then performing coagulation tests (platelet count, PT, PTT) are necessary. Coagulation laboratory assessment (platelet count, PT, aPTT, Clauss fibrinogen) is recommended for patients on anticoagulation or in the presence of other clinical conditions which may impair coagulation (such as renal or liver disease) prior to IR procedure with risk of bleeding. Patients on anticoagulants with increased risk of thromboembolic complications planning to do elective IR procedure with low risk of bleeding can continue medication depends on type of procedure and its bleeding risk. Patients on anticoagulants with increased risk of thromboembolic complications and are planned an elective IR procedure with moderate or high risk of bleeding, withholding anticoagulation and bridging therapy is recommended.
Patients on anticoagulants requiring an immediate emergency IR procedure with low risk of bleeding can have IR procedure with omitting a dose of drug or during medication use.
Patients on anticoagulants requiring an immediate emergency IR procedure with moderate or high risk of bleeding can be treated with reversing anticoagulation and if they are at high risk of thrombosis, bridging therapy should be initiated.
For patients at risk of bleeding, attention should be given to apply pressure at puncture sites, supportive care and monitoring of vital signs. For patients on warfarin, discontinuing anticoagulation is recommended associated
with accelerated reversal with vitamin K.