title: Image-guided intervention in the coagulopathic patient.
abstract: Determining practice parameters for interventional procedures is challenging due to many factors including unreliable laboratory tests to measure bleeding risk, variable usage of standardized terminology for adverse events, poorly defined standards for administration of blood products, and the growing numbers of anticoagulant and antiplatelet medications. We aim to address these and other issues faced by radiologists performing invasive procedures through a review of available literature, and experiential guidance from three academic medical centers. We discuss the significant limitations with respect to using prothrombin-time and international normalized ratio to measure bleeding risk, especially in patients with synthetic defects due to liver function. Factors affecting platelet function including the impact of uremia; recent advances in laboratory testing, including platelet function testing; and thromboelastography are also discussed. A review of the existing literature of fresh-frozen plasma replacement therapy is included. The literature regarding comorbidities affecting coagulation including malignancy, liver failure, and uremia are also reviewed. Finally, the authors present a set of recommendations for laboratory thresholds, corrective transfusions, as well as withholding and restarting medications.
authors.affiliation: University of California, San Francisco, CA, USA. marc.kohli@ucsf.edu.
authors.forename: Marc
authors.identifier: 0000-0003-3720-0156
authors.initials: M
authors.lastname: Kohli
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Mayo-Smith
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Zagoria
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sandrasegaran
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D001778:Blood Coagulation Disorders / Q000150:complications*; D016913:Blood Component Transfusion; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D061705:Image-Guided Biopsy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015641:Radiography, Interventional; D018570:Risk Assessment
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulants; Biopsy; Blood coagulation disorders; Image-guided biopsy; Interventional radiology; Platelet aggregation inhibitors