Procedural anticoagulation management checklist

Evaluate baseline patient-specific risk factors from history, physical examination, and chart review

Family history of bleeding disorders

Physical examination: Signs of easy bruising including petechiae, mucosal bleeding, and ecchymoses

Renal and hepatic disease: Order laboratory tests to evaluate coagulation status

Evaluate coagulation tests if required (complete blood count, PT, aPTT)

Screening for antiplatelet, antithrombotic, or thrombolytic therapy

Identify non-ASA NSAID use

Categorize individual reason for ASA utilization

Primary prophylaxis: Absence of established cardiovascular disease or risk factor

Secondary prophylaxis: Presence of cardiovascular disease

Informed decision making involving procedural physician, prescribing medical physician, and patient

Identify and manage pharmacologic coagulopathies

Understand drug elimination and appropriate discontinuation time

Recognize other drugs that may alter coagulation (eg, SSRIs, SNRIs)

Process the anatomical location of procedural intervention into decision making

Cervical/thoracic versus lumbar/sacral neuraxial area

High-, intermediate-, or low-risk procedures

Review appropriate radiographic imaging to identify/understand anatomical challenges

Cervical, thoracic, lumbar spinal stenoses that alter spinal canal anatomy

Epidural fibrosis and significant scar tissue from previous surgical intervention

Appropriate timing for reinitiation of anticoagulation

Appropriate postprocedure surveillance and monitoring

PT: prothrombin time; aPTT: activated partial thromboplastin time; ASA: aspirin; NSAIDs: nonsteroidal anti-inflammatory drugs; SSRIs: selective serotonin reuptake inhibitors; SNRIs: serotonin and norepinephrine reuptake inhibitors.

Reproduced with permission from: Narouze S, Benzon HT, Provenzano DA, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulation medications (second edition): Guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 2018; 43(3):225-262. Copyright © 2018 BMJ Publishing Group Ltd.

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Procedural anticoagulation management checklist