title: Current practice of periprocedural haematological management for patients undergoing image-guided procedures.
abstract: OBJECTIVE
  To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest).
  
  
  METHODS
  Survey of practice in UK radiology departments conducted over a 1-year period
  
  
  RESULTS
  48 radiology departments responded. The percentage of departments that stop antithrombotics pre-procedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x10(3) cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters.
  
  
  CONCLUSIONS
  Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required.
  
  
  CONCLUSIONS
  This study demonstrates wide variation in practice in haematological management for image-guided procedures.
authors.affiliation: 1 Department of Diagnostic Imaging, Barts Health NHS Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kyaw Tun
authors.forename: S
authors.initials: S
authors.lastname: Khwaja
authors.forename: S
authors.initials: S
authors.lastname: Flanagan
authors.forename: T
authors.initials: T
authors.lastname: Fotheringham
authors.forename: D
authors.initials: D
authors.lastname: Low
mesh_terms: D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010976:Platelet Count; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D025321:Surgery, Computer-Assisted; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents