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Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 4, pp 451–460 | Cite as

A retrospective analysis of the periprocedural management of oral anticoagulants in patients undergoing interventional radiology procedures

  • Kassandra Marsh
  • Tania Ahuja
  • Veronica Raco
  • David Green
  • Akhilesh K. Sista
  • John Papadopoulos
Article

Abstract

Limited evidence is available to guide periprocedural management of oral anticoagulants in the setting of interventional radiology (IR) procedures. For direct oral anticoagulants, therapy interruption (TI) is based on medication half-life and procedural bleeding risk. Periprocedural management of warfarin includes INR monitoring, and possible bridging with parenteral anticoagulants. It is unknown if these recommendations apply to IR procedures. To evaluate bleeding complications and thromboembolic events following periprocedural management of the factor Xa (FXa) inhibitors or warfarin in patients undergoing IR procedures. We performed a retrospective, observational study at NYU Langone Health (NYULH) of all adult patients who underwent an IR procedure from January 2015 to July 2017 and were receiving apixaban, rivaroxaban, or warfarin. Patients who were pregnant or who had a mechanical heart valve were excluded. At NYULH, TI is not required for FXa inhibitors, and an INR < 3 is recommended for patients on warfarin undergoing low risk procedures. For moderate/high risk procedures, TI for 48 h or 72 h with reduced renal function, is recommended for FXa inhibitors, and an INR < 1.5 is recommended for patients on warfarin. We evaluated 350 IR procedures, with a total of 174 low bleeding risk and 176 moderate/high bleeding risk. The 30-day major bleeding rate was 0.9%, clinically relevant non-major bleeding rate was 3%, minor bleeding rate was 1% and thromboembolic event rate was 1%. The periprocedural oral anticoagulation management strategy at NYULH appears safe given the low 30-day incidence of bleeding and thromboembolic events.

Keywords

Anticoagulants Apixaban Factor Xa inhibitors Hemorrhage Interventional radiology Periprocedural Rivaroxaban Venous thromboembolism Warfarin 

Notes

Author contributions

All authors have fulfilled the conditions required for authorship. KM performed research, analyzed and interpreted data, and wrote the first draft of the manuscript. TA designed research, interpreted data and provided vital review and oversight of the research and the manuscript. VR interpreted data and provided reviews of the manuscript. DG, AS, and JP provided vital reviews of the manuscript. The final version of this manuscript has been read and approved for submission by all authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

11239_2018_1740_MOESM1_ESM.pdf (269 kb)
Supplementary material 1 (PDF 269 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PharmacyNYU Langone HealthNew YorkUSA
  2. 2.Division of Hematology, Department of MedicineNYU Langone HealthNew YorkUSA
  3. 3.Division of Vascular Interventional Radiology, Department of RadiologyNYU Langone HealthNew YorkUSA

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