Template:Low risk of bleeding

Coagulation

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

Required lab test

• Prothrombin time (PT or INR), within 24 hours for inpatients. Within 2 weeks for those with a healthy liver. Within 1 week for those with liver disease and no additional acute disease since then.

Lab interpretation

• INR should be corrected if over 2.0
• If partial thromboplastin time (aPTT or APTT) has been taken, 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

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