Interventional Radiology and Anticoagulants: A Practical Playbook

Use a conservative plan that matches the expected bleeding risk of the IR procedure and the patient factors. Coordinate with IR for cases that could escalate.

Clarify the planned intervention

Biopsy, drain placement, port creation, ablation, and line work do not carry the same risk. If escalation is possible, plan for the higher risk path.

DOACs and warfarin in IR

• DOACs: hold based on risk, do not bridge, and restart after hemostasis is secure. If renal function is reduced, extend holds conservatively.
• Warfarin: stop 5 days for most elective cases. Check INR near the procedure. Bridge only for high thrombosis risk and consider UFH if creatinine clearance is less than 30.

Examples

• Liver biopsy on rivaroxaban: treat as higher risk. Hold longer and restart later after hemostasis is clear.
• Port placement on apixaban: match hold to risk. If bleeding risk is low, a shorter hold may be appropriate with a careful restart plan.
• Tunneled line exchange on warfarin: stop 5 days and check INR. Bridge only if risk is high.

For a timestamped plan that matches IR categories and patient factors, use the AnticoagPlanner calculator.

Sources

• MD Anderson. Peri Procedure Anticoagulants, V8 approved 2025.
• Institutional neuraxial catheter timing summaries derived from ASRA guidance for neuraxial contexts.