Template:Low risk of bleeding

Author: Mikael Häggström

Coagulation: Moderate risk of bleeding

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

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 1.5
• 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 ≤ 1.5
• 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 2 days (48 hours) before
• Glomerular filtration rate less than 30 ml/min: Stop 3 days (72 hours) before

• Clopidogrel (Plavix), prasugrel (Efient), ticagrelor (Brilinta, Brilique, and Possia): Stop 5 days before
• Dipyridamole (Persantine): Stop 2 days (48 hours) before
• NSAIDs (including aspirin): No need to stop

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Example procedures

• Biopsy / drainage in the abdomen including liver biopsy and gallbladder drainage (not ascites drainage)
• Biopsy / drainage in the thorax including lung biopsy (not pleural drainage)