Management of Antiplatelet and Anticoagulant Therapy in the Context of Ultrasound-Guided Invasive Procedures

The growing use of antiplatelet (APT) and anticoagulant therapies (ACT) in an aging population has created increasing challenges when patients require invasive procedures, including those performed under ultrasound (US) guidance. Interrupting these agents may reduce bleeding risk but exposes patients to thromboembolic complications, while continuing therapy may be safe for many low-risk procedures. Current clinical practice remains highly variable and often inconsistent with emerging evidence. This narrative review aims to synthesize contemporary data, guideline recommendations, and real-world evidence regarding periprocedural management of APT and ACT during common ultrasound-guided invasive procedures. The primary goal is to provide clinicians with a practical, evidence-based framework to determine when antithrombotic therapy can be safely continued and when temporary interruption is warranted. We summarize key determinants of periprocedural decision-making-including procedure-specific bleeding risk, patient thrombotic risk, drug class and pharmacokinetics, renal function, and availability of reversal agents-and review evidence across major ultrasound-guided interventions (liver biopsy, paracentesis, thoracentesis, musculoskeletal procedures, breast and head-neck biopsies, and kidney biopsy). Emerging data consistently support a more permissive approach for low-risk procedures performed with ultrasound guidance, whereas moderate- and high-risk procedures still require individualized management and potential temporary drug cessation. Most ultrasound-guided procedures can be safely performed without discontinuing APT or ACT, provided that clinical context and procedural risk are carefully assessed. Standard laboratory abnormalities alone are poor predictors of bleeding, and routine prophylactic transfusions are discouraged. Further prospective studies are needed to refine decision thresholds and support guideline harmonization.