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
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.