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TRA IR Anticoagualtion Guidlelines
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Adapted for TRA from the Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations. (J Vasc Interv Radiol 2019; 30:1168–1184)
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PROCEDURELOW BLEEDING RISK PROCEDUREHIGH BLEEDING RISK PROCEDURE
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ARTERIAL ANGIOGRAM/INTERVENTIONS SHEATH ≤ 6 F, EMBOLOTHERAPYARTERIAL INTERVENTIONS: ≥ 7-F SHEATH, AORTIC, PELVIC, MESENTERIC, CNS (I.E. UFE)
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AV FISTULA/GRAFT EVALUATION/INTERVENTIONBILIARY INTERVENTIONS (INCLUDING CHOLECYSTOSTOMY TUBE PLACEMENT)
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BACLOFEN PUMP STUDYCATHETER DIRECTED THROMBOLYSIS (DVT, PE, PORTAL VEIN)
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BILIARY CATHETER REMOVAL/EXCHANGEDEEP ABSCESS DRAINAGE (I.E. LUNG PARENCHYMA, ABDOMINAL, PELVIC & RETROPERITONEAL COMPARTMENTS)
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BONE BIOPSY (SUPERFICIAL; EXCLUDES VERTEBRAL BODY)DEEP NON-ORGAN BIOPSIES (I.E. SPINE, SOFT TISSUE IN INTRAABDOMINAL, RETROPERITONEAL & PELVIC COMPARTMENTS)
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BONE MARROW BIOPSYDEEP PERCUTANEOUS DRAIN PLACEMENT (I.E. ABSCESS DRAIN)
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CENTRAL LINE OR PORT EVALUATION/INJECTIONDEEP SOFT TISSUE BIOPSY/ASPIRATION/DRAINAGE (INTRATHORACIC OR INTRA ABDOMINAL)
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CHECK/EXCHANGE PERCUTANEOUS CATHETER DRAIN (I.E. ABSCESS DRAIN)FACET JOINT INJECTION (CERVICAL)
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CHEST TUBE NON-TUNNELED/TUNNELEDGASTROSTOMY/JEJUNAL/GASTRIC-JEJUNAL FEEDING TUBE ORIGINAL PLACEMENT
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DOUBLE J URETERAL STENT PLACEMENT W/ PRE-EXISTING ACCESSINTRA ABDOMINAL SOLID ORGAN BIOPSY (LIVER,SPLEEN BIOPSY)
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FACET JOINT INJECTION (NON-CERVICAL)IVC FILTER REMOVAL COMPLEX
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GASTROSTOMY/GASTROJEJUNAL/JEJUNAL TUBE REMOVAL/EXCHANGE (MATURE TRACT)PORTAL VEIN INTERVENTIONS
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IVC FILTER PLACEMENT/REMOVAL (ROUTINE)SOLID ORGAN BIOPSIES (LIVER, KIDNEY, SPLEEN, LUNG)
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JOINT ASPIRATION AND JOINT INJECTIONS (ARTHROGRAM AND ARTHROCENTESIS)SPINE PROCEDURES WITH RISK OF SPINAL OR EPIDURAL HEMATOMA (I.E. LP, KYPHOPLASTY, VERTEBROPLASTY, EPIDURAL INJECTIONS, FACET BLOCKS CERVICAL SPINE)
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NEPHROSTOGRAM, LOOPOGRAM OR NEPHROSTOMY TUBE REMOVAL (MATURE TRACK)TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
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NEPHROSTOMY REMOVAL/EXCHANGEURINARY TRACT INTERVENTIONS (INCLUDING NEPHROSTOMY TUBE PLACEMENT, URETERAL DILATION, STONE REMOVAL)
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NON-TUNNELED CENTRAL LINE PLACEMENT AND REMOVALVENOUS INTERVENTIONS: INTRATHORACIC AND CNS INTERVENTIONS
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NON-TUNNELED DIALYSIS LINE PLACEMENT AND REMOVAL
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PARACENTESIS
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PICC LINE PLACEMENT
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PORT PLACEMENT
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PORT REMOVAL
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SI JOINT STEROID INJECTION
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SUPERFICIAL SOFT TISSUE BIOPSY/ASPIRATION/DRAINAGE (NOT INTRATHORACIC OR INTRA ABDOMINAL; PALPABLE LESION, LYMPH NODE, SOFT TISSUE, BREAST,)
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THORACENTESIS
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THYROID BIOPSY
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TRANSFORAMINAL SELECTIVE NERVE ROOT STEROID INJECTION CERVICAL/THORACIC/LUMBAR
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TRANSJUGULAR LIVER BIOPSY
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TUNNELED CATHETER PLACEMENT (DIALYSIS/CENTRAL LINE)
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TUNNELED CATHETER REMOVAL
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VENOGRAM/VENOUS INTERVENTIONS: PELVIS AND EXTREMITIES; NOT INTRATHORACIC OR CNS)
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Pre Procedure Screening Coagulation Laboratory Test
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Low Bleeding Risk ProceduresHigh Bleeding Risk Procedures
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PT/INRNot routinely recommendedRecommended
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HEMAGLOBINNot routinely recommendedRecommended
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PLATELETNot routinely recommendedRecommended
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INFOINR: Correct to range of 2.0 - 3.0/Platelet: Transfuse for < 20,000INR: Correct to within range of ≤ 1.5–1.8/Platelet: Transfuse if < 50
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Suggested Laboratory Thresholds for Performance of a Procedure in Patients with Chronic Liver Disease
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INRNA< 2.5
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Platelet> 20,000> 30,000
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Fibrinogen (mg/dL)> 100,000> 100,000
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The suggested laboratory thresholds and strategies for correction are based on expert opinion. The addition of a fibrinogen level to laboratory testing for patients with chronic liver disease who plan to undergo a procedure may be helpful.
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Recommendation low platelets: administer a dose of platelets in patients with a large spleen if platelet count is below suggested thresholds.
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Recommendation for low fibrinogen: administer 1 dose (body weight < 80 kg) or 2 doses (body weight > 80 kg) of cryoprecipitate.
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