INPATIENT PROCEDURE GUIDELINES

lower risk procedures

higher risk procedures

labs and management

No pre-procedural labs unless specified below

Do not hold ASA/clopidogrel (Plavix)

Do not hold warfarin (Coumadin)/heparin/ other anticoagulants

Do not transfuse platelets

Platelet count	Transfuse platelets for counts < 50,000 after discussion with AOC Physician
Known liver disease	If INR <2, no intervention required. If INR greater than or equal to 2, discuss with AOC physician.
Warfarin (Coumadin)	Pre-procedure INR if the patient is on warfarin – Hold Coumadin 5 days with goal INR <1.5. – For emergent major bleed or emergent procedure required within 6 hours – Kcentra. Otherwise, Vitamin K recommended or FFP.
Other oral anticoagulants	dabigatran (Pradaxa): Hold 2 days if renal function is normal, 5 days if elderly or with compromised renal function rivaroxaban (Xarelto): Hold 1 day apixaban (Eliquis): Hold 2 days
Antiplatelets	ASA/clopidogrel (Plavix): Do not hold unless stated to do so below Prasugrel (Effient): Hold 7 days (binds to receptor) Ticagrelor (Brilinta): Hold 5 days (competitively inhibit, i.e. reversible )
Injectable anticoagulants	Fondaparinux (Arixtra): Hold 1 day Prophylactic SQ heparin or enoxaparin (Lovenox): Hold 2 prior doses; may proceed if these drugs have not been held at MD discretion Therapeutic enoxaparin (Lovenox) or other LMWH: Hold 24 hours IV heparin: Hold 2 hours prior to procedure

Procedures

Deep Brachial/Ext jugular/Intra-osseus

Central venous access (all types)

Abscess drainage

Arthrocentesis

Cutaneous biopsy

Chest tube/PleurX catheter	Image-guided biopsy/aspiration
Hemodialysis vascular catheter	Bone marrow biopsy (need CBC, transfuse platelets<20,000)
Thoracentesis (treat INR>2.0)	Paracentesis (treat INR>2.5)
Lumbar puncture (hold ASA/Plavix 5 days)