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

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.