[wendirn]

I am trying to establish guideline for labs and blood thinners prior to interventional radiology. I do biopsies, para and thoracentesis, myelograms.
My doc wants research on how long to hold ASA, coumadin, plavix, lovenox and NSAIDS. Also what the protocol on labs are, ie within 1 week, two weeks or one month.
tx

[dianah]

Wow, that's pretty challenging. You'll have to do some literature and online searching, I don't think picking our brains will give you the hard data you seek, although it may give you an idea of what is done in practice, in various areas.

You may want to contact a Medical Center that runs an Interventional Radiology Fellowship, or pick up an Interventional Radiology text (or two, or more, to compare).

Our practice for cardiac caths is: D/C Coumadin (warfarin) X 4days prior to cath, get an INR the morning of the cath.
Wait X 6 hr post Lovenox dose to perform cath.
Don't hold ASA (the benefit of the ASA out-weighs the risk of holding it, even on the morning of the cath).
Don't hold Plavix (same rationale as ASA, however if the pt needs bypass surgery, the surgeons are VERY reluctant to proceed if the pt has taken plavix that day).
Don't hold NSAIDS.

Now, the biopsies would require a different approach, depending on the organ or area to be biopsied. Liver, Lung, Renal Bx come to mind as those most needing careful pre-bx medication mgmt (or a transjugular approach for the Liver bx, if a coagulopathy exists).

I just did a quick Google search, and came up with mainly patient recommendations, which were, by and large, "inform your physician of any medications you take, including blood thinners or aspirin or herbal supplements, as you may need to discontinue these for several days before the biopsy."

We used to give out a post-biopsy patient information sheet that instructed pts to only take Tylenol for pain, not Ibuprofen, for 48 hr.

I'm sorry I haven't more solid, evidence-based information to give you, but do check into the Interventional Radiology textbooks. Good luck!

[TGreen]

In our DI department we do the procedures that you mentioned above and I'd be glad to share our protocols with you. For all outpatient interventional procedures ASA is to be held for 7 days, plavix for three days. If the patient is on coumadin it is held until the INR is < or = 1.5. For inpatients the PTT is 35 or less, if the patient is currently on heparin it is to be held for 4 hours with a PTT then drawn. If 35 or less then procedure is done. INR must be 1.5 or less. ASA, plavix, lovenox, aggranox, etc. are held the morning of and stat PTT and Protime are drawn. Occasionally a para will be done with an INR higher than 1.5 due to the fact that pts. with chronic liver disease will have higher INR,s due to the liver failure. Picc lines are never done by an RN if the INR is <1.5 but in an emergency such as pt going to the OR the Radiologist may choose to place the PICC themselves but if no exstenuating circumstances, Coags are rechecked the following am. The ordering Dr. can decide to order vit K or FFP's to speed up the procedure if desired. I hope this helps. If your radiologists stands behind the protocols they approve you won't have any problems.

[hawks5]

Evidence supports the use of vitamin K as referenced above. Rather than holding coumadin 3-5 days or starting Lovenox. We have patients hold coumadin the night before and then take a 5 or 10 mg po vit k, depending on their most recent PT/INR. Very effective.
Plavix has caused us some grief. When doing lung or liver biopsies, the Radiologists want the patients off of plavix for at least a week. However, if the patient has a known drug-eluding coronary stent in place- the cardiologists say Do Not take my patient off plavix and find a radiologist who will do it despite the plavix...

[TGreen]

We leave the decision to give vit k up to the ordering Dr. and or cardiologist. Basically we are saying this is where we need their INR to be to do the procedure. How do you want to proceed. I have not noticed much trouble regarding plavix and liver or lung biopsies but according to our interventionalist new studies have shown a high risk for hematomas if the patients have not been off plavix for three days for any type of spinal procedures such as a myelogram etc.