Reference
IR & anticoagulation
Pre-procedure labs, INR / platelet thresholds, and anticoagulant hold parameters by procedure bleeding risk. Based on SIR consensus guidelines (Patel et al., 2019).
| Procedure | Bleed risk | INR target | Platelets | Anticoagulant hold |
|---|
Warfarin
Hold 5 days for moderate / high-bleed-risk procedures. Bridge with LMWH for high thromboembolic risk patients (mechanical valve, recent VTE).
DOACs (apixaban, rivaroxaban, dabigatran)
Hold 24-48 h for moderate / high-risk procedures depending on renal function. Restart 24 h post-procedure if hemostasis adequate.
Antiplatelets
Aspirin generally continued. Hold clopidogrel/prasugrel/ticagrelor 5-7 days for moderate / high-risk procedures.
Patient-specific risk always wins.
These thresholds are a starting point. Discuss with the proceduralist when there's competing thromboembolic risk (recent stent, mechanical valve, AF + prior CVA) — bridging strategy is highly individualized.