Template:Low risk of bleeding

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Author: Mikael Häggström [notes 1]

Coagulation: Low risk of bleeding

This procedure counts as conferring a relatively low risk of clinically significant bleeding.[1]

Required lab test

Prothrombin time (PT or INR):

  • Inpatients: within 24 hours
  • Outpatients with a healthy liver: Within 2 weeks
  • Outpatients with liver disease and no additional acute disease since then: Within 1 week

Lab interpretation

  • INR should be corrected if over 2.0
  • If partial thromboplastin time (aPTT or APTT) has been tested, it should be corrected if over 1.5 times its normal upper limit.
  • If platelet count has been performed, transfusion is indicated if it is below 50 x 109/L (equals 50,000/µL).

Anticoagulant medication

  • Coumarin (warfarin): Normally stop 3-5 days before, in order to reach INR ≤ 2.0
  • Low-molecular-weight heparin (LMWH): Stop 1 preceding dose
  • Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa, Lixiana):
  • Glomerular filtration rate over 30 ml/min: Stop 24 hours before
  • Glomerular filtration rate less than 30 ml/min: Stop 48 hours before
  • Clopidogrel (Plavix), prasugrel (Efient), ticagrelor (Brilinta, Brilique, and Possia): Stop 5 days before
  • Dipyridamole (Persantine): Stop 48 hours before
  • NSAIDs (including aspirin): No need to stop

Tailoring

Prothrombin time (PT or INR) can be put as not necessary by including the template as:
{{Low risk of bleeding|PT=no}}

Example procedures

  • Nephrostomy tube change
  • Catheter insertion into plaura or peritoneum
  • Superficial biopsies and drainage (neck, extremities and walls of thorax and abdomen
  • Suprapubic catheter insertion

See also

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. The coagulation section follows local practice at: Pathology Department at NU Hospital Group, Sweden, 2019-2020.