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CAR/CAIR Practice Guidelines: Periprocedural Management of Patient Bleeding Risk.

Kelly Harper1, Casey Hurrell2, Ashish Gupta3

  • 1Department of Radiology: Abdominal Imaging & Intervention, University of Ottawa & The Ottawa Hospital, ON, Canada.

Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes
|April 11, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Canadian radiology guidelines offer practical recommendations for managing bleeding risk during image-guided procedures, emphasizing individualized care and avoiding unnecessary testing for most patients undergoing interventional radiology. These updated guidelines streamline decision-making for anticoagulation, antiplatelet therapy, and transfusion thresholds.

Keywords:
ablation techniquesanticoagulantsantiplatelet therapyblood coagulation testshemorrhageimage-guided proceduresinterventional radiologylumbar punctureperiprocedural managementrisk assessment

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Area of Science:

  • Radiology
  • Interventional Radiology
  • Hematology

Background:

  • Existing guidelines for managing bleeding risk in interventional radiology procedures require updates based on recent evidence.
  • Canadian practice guidelines need to be streamlined for consistent application across radiology departments.

Purpose of the Study:

  • To provide evidence-informed, practical recommendations for managing bleeding risk during image-guided procedures.
  • To update and streamline decision-making processes regarding anticoagulation, antiplatelet therapy, laboratory testing, and transfusion thresholds.

Main Methods:

  • Systematic review of evidence published after 2019.
  • Expert consensus to inform updates on procedural risk stratification.
  • Clarification of international normalized ratio (INR) and platelet thresholds.

Main Results:

  • Most radiologic procedures have a very low bleeding risk, often not requiring routine laboratory screening or medication interruption.
  • High-risk procedures necessitate targeted testing and standardized transfusion thresholds, including specific considerations for chronic liver disease.
  • Guidance addresses specific procedures like lumbar puncture and arterial access, as well as urgent cases.

Conclusions:

  • The guidelines promote individualized clinical judgment and avoidance of unnecessary delays or consultations.
  • Emphasis is placed on careful consideration of transfusion risks to ensure safe and consistent patient care.
  • Streamlined, safe, and consistent care across Canadian imaging practices is the primary goal.