Bleeding risk associated with invasive procedures
| High-risk procedures All major surgeries (cardiac, intra-abdominal, orthopedic, brain, spine) Intracranial pressure catheter insertion Endoscopy: large polypectomy with endoscopic mucosal resection or submucosal resection |
| Moderate-risk procedures Lumbar puncture Percutaneous or transjugular liver biopsy Transarterial or percutaneous therapies for hepatocellular carcinoma Transjugular intrahepatic portosystemic shunt Endoscopy for percutaneous gastrostomy placement, biliary sphincterotomy |
| Low-risk procedures Paracentesis Thoracocentesis Dental extraction Cardiac catheterization Central line placement Endoscopy for diagnosis, variceal band ligation, uncomplicated polypectomy |
Note: Risk is calculated based on relative vascularity, expected vascular breech, and potential clinical consequences. Risk should always be defined by the clinician performing the procedure.
Adapted from Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in haemostasis and thrombosis associated with liver disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118(8):1491–1506. doi:10.1055/s-0038-1666861, reference 55.