Skip to main content

Advertisement

SpringerLink
Log in

Peri-procedural use of anticoagulants in radiology: an evidence-based review

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Peri-procedural anticoagulant management hinges on the balance of hemorrhagic and thrombotic complications. The radiologist is tasked with accurately assessing the hemorrhagic risk for patients undergoing procedures, taking into account procedural bleeding rates, underlying coagulopathy based on lab tests, and use of anticoagulants. The purpose of this article is to provide a contemporary review of commonly used anticoagulants and, incorporating published evidence, review their management related to image-guided procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Coleman JL, Alberts MJ (2006) Effect of aspirin dose, preparation, and withdrawal on platelet response in normal volunteers. Am J Cardiol 98(6):838–841

    Article  CAS  Google Scholar 

  2. Patrono C, Baigent C, Hirsh J, Roth G (2008) Antiplatelet drugs: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 133(6):199S–233S

    Article  CAS  Google Scholar 

  3. Benzon HT, Avram MJ, Green D, Bonow RO (2013) New oral anticoagulants and regional anaesthesia. Br J Anaesth 111(1):i96–i113

    Article  CAS  Google Scholar 

  4. Narouze S, Benzon HT, Provenzano DA, et al. (2015) Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 40(3):182–212

    Article  CAS  Google Scholar 

  5. Jimenez AH, Stubbs ME, Tofler GH, et al. (1992) Rapidity and duration of platelet suppression by enteric-coated aspirin in healthy young men. Am J Cardiol 69(3):258–262

    Article  CAS  Google Scholar 

  6. Douketis JD, Berger PB, Dunn AS, et al. (2008) The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 133(6):299S–339S

    Article  CAS  Google Scholar 

  7. Moshfegh K, Redondo M, Julmy F, et al. (2000) Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 36(3):699–705

    Article  CAS  Google Scholar 

  8. Douketis JD, Spyropoulos AC, Spencer FA, et al. (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2):e326S–e350S

    Article  CAS  Google Scholar 

  9. Baron TH, Kamath PS, McBane RD (2013) Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med 368(22):2113–2124

    Article  CAS  Google Scholar 

  10. Walenga JM, Lyman GH (2013) Evolution of heparin anticoagulants to ultra-low-molecular-weight heparins: a review of pharmacologic and clinical differences and applications in patients with cancer. Crit Rev Oncol/Hematol 88(1):1–18

    Article  Google Scholar 

  11. Asai F, Jakubowski JA, Naganuma H, et al. (2006) Platelet inhibitory activity and pharmacokinetics of prasugrel (CS-747) a novel thienopyridine P2Y12 inhibitor: a single ascending dose study in healthy humans. Platelets 17(4):209–217

    Article  CAS  Google Scholar 

  12. Gurbel PA, Bliden KP, Butler K, et al. (2009) Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor vs. clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 120(25):2577–2585

    Article  CAS  Google Scholar 

  13. Abdulsattar Y, Ternas T, Garcia D (2011) Vorapaxar: targeting a novel antiplatelet pathway. Pharm Ther 36(9):564–568

    Google Scholar 

  14. Runyon BA (2009) Management of adult patients with ascites due to cirrhosis: an update. Hepatology 49(6):2087–2107

    Article  Google Scholar 

  15. Atwell TD, Smith RL, Hesley GK, et al. (2010) Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. Am J Roentgenol 194(3):784–789

    Article  Google Scholar 

  16. Westheim BH, Østensen AB, Aagenæs I, Sanengen T, Almaas R (2012) Evaluation of risk factors for bleeding after liver biopsy in children. J Pediatr Gastroenterol Nutr 55(1):82–87

    Article  Google Scholar 

  17. Corapi KM, Chen JL, Balk EM, Gordon CE (2012) Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 60(1):62–73

    Article  Google Scholar 

  18. Mackinnon B, Fraser E, Simpson K, Fox JG, Geddes C (2008) Is it necessary to stop antiplatelet agents before a native renal biopsy? Nephrol Dial Transplant 23(11):3566–3570

    Article  CAS  Google Scholar 

  19. Leavitt DA, Theckumparampil N, Moreira DM, et al. (2014) Second prize: continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-utilized? J Endourol 28(12):1399–1403

    Article  Google Scholar 

  20. Song YS, Park CM, Park KW, et al. (2013) Does antiplatelet therapy increase the risk of hemoptysis during percutaneous transthoracic needle biopsy of a pulmonary lesion? Am J Roentgenol 200(5):1014–1019

    Article  Google Scholar 

  21. Tai R, Dunne RM, Trotman-Dickenson B, et al. (2016) Frequency and severity of pulmonary hemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: single-institution experience of 1175 cases. Radiology 279(1):287–296

    Article  Google Scholar 

  22. Chetlen AL, Kasales C, Mack J, Schetter S, Zhu J (2013) Hematoma formation during breast core needle biopsy in women taking antithrombotic therapy. Am J Roentgenol 201(1):215–222

    Article  Google Scholar 

  23. Somerville P, Seifert PJ, Destounis SV, Murphy PF, Young W (2008) Anticoagulation and bleeding risk after core needle biopsy. Am J Roentgenol 191(4):1194–1197

    Article  Google Scholar 

  24. Abu-Yousef MM, Larson JH, Kuehn DM, Wu AS, Laroia AT (2011) Safety of ultrasound-guided fine needle aspiration biopsy of neck lesions in patients taking antithrombotic/anticoagulant medications. Ultrasound Quart 27(3):157–159

    Article  Google Scholar 

  25. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women (1994). CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet 343(8898):619–629

  26. Whellan DJ, Tricoci P, Chen E, et al. (2014) Vorapaxar in acute coronary syndrome patients undergoing coronary artery bypass graft surgery: subgroup analysis from the TRACER trial (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome). J Am Coll Cardiol 63(11):1048–1057

    Article  CAS  Google Scholar 

  27. Collet JP, Himbet F, Steg PG (2000) Myocardial infarction after aspirin cessation in stable coronary artery disease patients. Int J Cardiol 76(2–3):257–258

    Article  CAS  Google Scholar 

  28. Biondi-Zoccai GG, Lotrionte M, Agostoni P, et al. (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674

    Article  Google Scholar 

  29. Sibon I, Orgogozo JM (2004) Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology 62(7):1187–1189

    Article  Google Scholar 

  30. Baron TH, Kamath PS, McBane RD (2014) New anticoagulant and antiplatelet agents: a primer for the gastroenterologist. Clin Gastroenterol Hepatol 12(2):187–195

    Article  CAS  Google Scholar 

  31. Holbrook A, Schulman S, Witt DM (2012) Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141(2):e152S–e184S

    Article  CAS  Google Scholar 

  32. Hibbert RM, Atwell TD, Lekah A, et al. (2013) Safety of ultrasound-guided thoracentesis in patients with abnormal preprocedural coagulation parameters. Chest 144(2):456–463

    Article  Google Scholar 

  33. Patel MD, Joshi SD (2011) Abnormal preprocedural international normalized ratio and platelet counts are not associated with increased bleeding complications after ultrasound-guided thoracentesis. Am J Roentgenol 197(1):W164–W168

    Article  Google Scholar 

  34. Lin CH, Shih FY, Ma MM, et al. (2005) Should bleeding tendency deter abdominal paracentesis? Dig Liver Dis 37(12):946–951

    Article  Google Scholar 

  35. Ahmed I, Gertner E (2012) Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 125(3):265–269

    Article  Google Scholar 

  36. Wahl MJ (1998) Dental surgery in anticoagulated patients. Arch Intern Med 158(15):1610–1616

    Article  CAS  Google Scholar 

  37. Loke C, Ali SS, Johari V (2012) Pharmacology of anticoagulants. Disease-a-Month 58(8):424–430

    Article  Google Scholar 

  38. Blann AD, Landray MJ, Lip GY (2002) ABC of antithrombotic therapy: an overview of antithrombotic therapy. BMJ 325(7367):762–765

    Article  Google Scholar 

  39. Hirsh J, Raschke R, Warkentin TE, et al. (1995) Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest 108(4):258S–275S

    Article  CAS  Google Scholar 

  40. Franchini M, Bonfanti C, Mannucci PM (2015) Management of bleeding associated with new oral anticoagulants. Semin Thromb Hemost 41(7):788–801

    Article  CAS  Google Scholar 

  41. Ogata K, Mendell-Harary J, Tachibana M, et al. (2010) Clinical safety, tolerability, pharmacokinetics, and pharmacodynamics of the novel factor Xa inhibitor edoxaban in healthy volunteers. J Clin Pharmacol 50(7):743–753

    Article  CAS  Google Scholar 

  42. Deykin D, Gurewich V, Harker L, Hirsch J (1977) Treating thromboembolic disease. Geriatrics 32(10):119–121

    CAS  PubMed  Google Scholar 

  43. Velibey Y, Golcuk Y, Ekmekci A, et al. (2015) Tirofiban-induced acute profound thrombocytopenia: what is the optimal approach to treatment? Platelets 26(2):197–198

    Article  CAS  Google Scholar 

  44. Lipsky AH, Farooqui MZ, Tian X, et al. (2015) Incidence and risk factors of bleeding-related adverse events in patients with chronic lymphocytic leukemia treated with ibrutinib. Haematologica 100(12):1571–1578

    Article  Google Scholar 

  45. Imbruvica (R) [package insert]. Pharmacyclics LLC, Sunnyvale, CA; June 2016. Available from: https://www.imbruvicahcp.com/docs/librariesprovider2/pdf-downloads/prescribing_information.pdf. Accessed 14 June 2016

  46. Lee JM, Hays JL, Noonan AM, et al. (2013) Feasibility and safety of sequential research-related tumor core biopsies in clinical trials. Cancer 119(7):1357–1364

    Article  CAS  Google Scholar 

  47. Erinjeri JP, Fong AJ, Kemeny NE, et al. (2011) Timing of administration of bevacizumab chemotherapy affects wound healing after chest wall port placement. Cancer 117(6):1296–1301

    Article  CAS  Google Scholar 

  48. Abrams DA, Hanson JA, Brown JM, et al. (2015) Timing of surgery and bevacizumab therapy in neurosurgical patients with recurrent high grade glioma. J Clin Neurosci 22(1):35–39

    Article  CAS  Google Scholar 

  49. Thornton AD, Ravn P, Winslet M, Chester K (2006) Angiogenesis inhibition with bevacizumab and the surgical management of colorectal cancer. Br J Surg 93(12):1456–1463

    Article  CAS  Google Scholar 

  50. Powles T, Kayani I, Blank C, et al. (2011) The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Annal Oncol 22(5):1041–1047

    Article  CAS  Google Scholar 

  51. Meijer WE, Heerdink ER, Nolen WA, et al. (2004) Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Arch Intern Med 164(21):2367–2370

    Article  Google Scholar 

  52. Skop BP, Brown TM (1996) Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors. Psychosomatics 37(1):12–16

    Article  CAS  Google Scholar 

  53. de Abajo FJ, Rodriguez LA, Montero D (1999) Association between selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: population based case-control study. BMJ 319(7217):1106–1109

    Article  Google Scholar 

  54. Jeong BO, Kim SW, Kim SY, et al. (2014) Use of serotonergic antidepressants and bleeding risk in patients undergoing surgery. Psychosomatics 55(3):213–220

    Article  Google Scholar 

  55. Srivastava KC (1986) Evidence for the mechanism by which garlic inhibits platelet aggregation. Prostaglandins, Leukot Med 22(3):313–321

    Article  CAS  Google Scholar 

  56. Stanger MJ, Thompson LA, Young AJ, Lieberman HR (2012) Anticoagulant activity of select dietary supplements. Nutr Rev 70(2):107–117

    Article  Google Scholar 

  57. Koch E (2005) Inhibition of platelet activating factor (PAF)-induced aggregation of human thrombocytes by ginkgolides: considerations on possible bleeding complications after oral intake of Ginkgo biloba extracts. Phytomedicine 12(1–2):10–16

    Article  CAS  Google Scholar 

  58. Harker LA, Kelly AB, Hanson SR, et al. (1993) Interruption of vascular thrombus formation and vascular lesion formation by dietary n-3 fatty acids in fish oil in nonhuman primates. Circulation 87(3):1017–1029

    Article  CAS  Google Scholar 

  59. Gajic O, Rana R, Winters JL, et al. (2007) Transfusion-related acute lung injury in the critically ill: prospective nested case-control study. Am J Respir Crit Care Med 176(9):886–891

    Article  Google Scholar 

  60. Webert KE, Blajchman MA (2003) Transfusion-related acute lung injury. Transfus Med Rev 17(4):252–262

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55902, USA

    Thomas D. Atwell, Brendan P. McMenomy & Naveen S. Murthy

  2. Department of Cardiovascular Disease, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55902, USA

    Paul W. Wennberg

  3. Department of Pharmacy, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55902, USA

    Jeremy R. Anderson

  4. Department of Radiology, Mayo Clinic College of Medicine, 13400 E. Shea Blvd., Scottsdale, 85259, AZ, USA

    J. Scott Kriegshauser

  5. Department of Radiology, Mayo Clinic College of Medicine, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    J. Mark McKinney

Authors
  1. Thomas D. Atwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul W. Wennberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brendan P. McMenomy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naveen S. Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeremy R. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Scott Kriegshauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Mark McKinney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas D. Atwell.

Ethics declarations

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Atwell, T.D., Wennberg, P.W., McMenomy, B.P. et al. Peri-procedural use of anticoagulants in radiology: an evidence-based review. Abdom Radiol 42, 1556–1565 (2017). https://doi.org/10.1007/s00261-016-1027-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-016-1027-x

Keywords

Search

Navigation