Image-guided intervention in the coagulopathic patient

Area of Science:

• Radiology
• Interventional Radiology
• Hematology

Background:

• Determining practice parameters for interventional procedures is difficult due to unreliable bleeding risk tests, inconsistent adverse event terminology, and evolving anticoagulant/antiplatelet use.
• Radiologists face challenges in managing patients undergoing invasive procedures, particularly concerning coagulation status and medication management.

Purpose of the Study:

• To address challenges faced by radiologists performing invasive procedures.
• To provide experiential guidance and literature review on managing bleeding risk and coagulation in interventional radiology.
• To offer recommendations for laboratory thresholds, transfusions, and medication management.

Main Methods:

• Review of available literature on coagulation testing, platelet function, and blood product administration.
• Analysis of experiential guidance from three academic medical centers.
• Discussion of limitations of current laboratory tests (e.g., prothrombin-time, international normalized ratio) for bleeding risk assessment.

Main Results:

• Significant limitations exist in using prothrombin-time and international normalized ratio for bleeding risk, especially in liver dysfunction.
• Factors affecting platelet function, including uremia, and advances in platelet function testing and thromboelastography are discussed.
• Literature on fresh-frozen plasma therapy and comorbidities (malignancy, liver failure, uremia) affecting coagulation is reviewed.

Conclusions:

• Current methods for assessing bleeding risk in interventional radiology are limited.
• Recommendations are provided for laboratory thresholds, corrective transfusions, and managing anticoagulant/antiplatelet medications.
• Improved guidelines are needed to enhance patient safety during invasive radiological procedures.