Evaluation of Bleeding Risk Prior to Invasive Procedures

Evaluation of bleeding risk prior to invasive procedures is important to minimize bleeding throughout the periprocedural period. A thorough bleeding assessment includes an evaluation of bleeding associated with the procedure in the presence and absence of anticoagulation, if applicable, and a patient assessment including personal and family history of bleeding events, medication history, physical evaluation, and past medical history including concomitant disease states. Patients on medications that affect hemostasis need to be properly managed around the time of procedure as per multidisciplinary assessment and evidence-based and/or expert consensus guidelines. A patient on antithrombotic therapy undergoing an invasive procedure/surgery with a high bleeding risk will need to temporarily interrupt antithrombotic agents. For urgent/emergent procedures that cannot be delayed, anticoagulation may require immediate reversal, and the patient may require additional hemostatic support throughout the periprocedural period. Creating a patient- and procedure-specific periprocedural anticoagulation management plan is an interdisciplinary task that should involve the proceduralist, anticoagulation management provider, and potentially the primary care provider, cardiologist, and oncologist depending on the indication for anticoagulation.