{"id":26005,"date":"2020-01-25T22:39:32","date_gmt":"2020-01-26T03:39:32","guid":{"rendered":"http:\/\/www.stepwards.com\/?page_id=26005"},"modified":"2025-03-21T22:45:39","modified_gmt":"2025-03-22T02:45:39","slug":"radiology-procedures-paracentesis-evaluating-bleeding-risk-using-laboratory-values","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=26005","title":{"rendered":"Radiology Procedures: Paracentesis (Evaluating Bleeding Risk Using Laboratory Values)"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#RISK_CLASSIFICATION_OF_A_PARACENTESIS\"><span class=\"toc_number toc_depth_1\">2<\/span> RISK CLASSIFICATION OF A PARACENTESIS<\/a><\/li><li><a href=\"#2013_ADDENDUM_TO_SIR_CONSENSUS_GUIDELINES\"><span class=\"toc_number toc_depth_1\">3<\/span> 2013 ADDENDUM TO SIR CONSENSUS GUIDELINES\u00a0<\/a><\/li><li><a href=\"#2019_SIR_CONSENSUS_GUIDELINES\"><span class=\"toc_number toc_depth_1\">4<\/span> 2019 SIR CONSENSUS GUIDELINES\u00a0<\/a><\/li><li><a href=\"#GUIDELINES_FOR_SPECIAL_PATIENT_POPULATIONS\"><span class=\"toc_number toc_depth_1\">5<\/span> GUIDELINES FOR SPECIAL PATIENT POPULATIONS<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>An important component of assessing the risk of a paracentesis\u00a0 procedure is to assess the patient&#8217;s risk of bleeding. There are multiple factors that contribute to the risk of bleeding in a patient, and one of those factors are relevant lab values that will be discussed on this page. It is important to realize however that other factors such as the anticoagulation\/antithrombotic medications that the patient is taking (<a href=\"http:\/\/www.stepwards.com\/?page_id=25568\">discussed separately on this page here<\/a>) should also be taken into consideration.<\/p>\n<p>For more general information on evaluating bleeding risk for radiology procedures by evaluating laboratory values please <a href=\"http:\/\/www.stepwards.com\/?page_id=26004\">refer to this page here<\/a>.<\/p>\n<h5><span id=\"RISK_CLASSIFICATION_OF_A_PARACENTESIS\"><span style=\"text-decoration: underline;\">RISK CLASSIFICATION OF A PARACENTESIS<\/span><\/span><\/h5>\n<p>Most all of the commonly used guidelines characterize a paracentesis as a &#8220;low bleeding risk procedure&#8221; which in turn informs the laboratory thresholds that should be applied as contraindications to the procedure.<\/p>\n<p>Given that there is more then one guideline, some of them are listed here below to clarify specific recommendations.<\/p>\n<h5><span id=\"2013_ADDENDUM_TO_SIR_CONSENSUS_GUIDELINES\"><span style=\"text-decoration: underline;\">2013 ADDENDUM TO SIR CONSENSUS GUIDELINES\u00a0<\/span><\/span><\/h5>\n<p><a href=\"https:\/\/www.jvir.org\/article\/S1051-0443(12)01238-9\/abstract\">This 2013 addendum to the prior 2009 SIR consensus guidelines<\/a> makes the following recommendations for a low risk procedure like a paracentesis:<\/p>\n<ul>\n<li><b>Routine laboratory tests: <\/b>INR\/aPTT (platelets not recommended unless risk of thrombocytopenia in the patient)<\/li>\n<li><strong>INR value: \u2264 <\/strong>2.0<\/li>\n<li><b>Platelet level: <\/b>&gt; 50,000\/\u00b5L<\/li>\n<\/ul>\n<h5><span id=\"2019_SIR_CONSENSUS_GUIDELINES\"><span style=\"text-decoration: underline;\">2019 SIR CONSENSUS GUIDELINES\u00a0<\/span><\/span><\/h5>\n<p><a href=\"https:\/\/www.jvir.org\/article\/S1051-0443(19)30407-5\/fulltext\">The 2019 SIR consensus guidelines<\/a> make the following recommendations for a low risk procedure like a paracentesis:<\/p>\n<ul>\n<li><b>Routine laboratory tests: <\/b>None (unless the patient is at risk of an elevated INR or thrombocytopenia)<\/li>\n<li><strong>INR value: \u2264 <\/strong>range from 2.0 &#8211; 3.0<\/li>\n<li><b>Platelet level: &gt; <\/b>20,000\/\u00b5L<\/li>\n<\/ul>\n<h5><span id=\"GUIDELINES_FOR_SPECIAL_PATIENT_POPULATIONS\"><span style=\"text-decoration: underline;\">GUIDELINES FOR SPECIAL PATIENT POPULATIONS<\/span><\/span><\/h5>\n<p>Certain guidelines have specific recommendations for special populations of patients. These are included below:<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>PATIENTS WITH CHRONIC LIVER DISEASE <\/strong><\/span><\/p>\n<p><a href=\"https:\/\/www.jvir.org\/article\/S1051-0443(19)30407-5\/fulltext\">The 2019 SIR consensus guidelines<\/a> make the following recommendations for a low risk procedure like a paracentesis in patients who have chronic liver disease (which can be a common co-morbidity for patients who are referred for a paracentesis):<\/p>\n<ul>\n<li><b>Routine laboratory tests: <\/b>Platelet count, fibrinogen level (NOT INR)<\/li>\n<li><strong>INR value: <\/strong>None<\/li>\n<li><b>Platelet level: &gt;<\/b>\u00a020,000\/\u00b5L<\/li>\n<li><b>Fibrinogen level:\u00a0<\/b>&gt; 100 mg\/dL<\/li>\n<\/ul>\n<h5><\/h5>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<pre>Page Updated: 01.09.2020<\/pre>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 RISK CLASSIFICATION OF A PARACENTESIS3 2013 ADDENDUM TO SIR CONSENSUS GUIDELINES\u00a04 2019 SIR CONSENSUS GUIDELINES\u00a05 GUIDELINES FOR SPECIAL PATIENT POPULATIONS OVERVIEW An important component of assessing the risk of a paracentesis\u00a0 procedure is to assess the patient&#8217;s risk of bleeding. There are multiple factors that contribute to the risk of bleeding in &#8230; <a title=\"Radiology Procedures: Paracentesis (Evaluating Bleeding Risk Using Laboratory Values)\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=26005\" aria-label=\"More on Radiology Procedures: Paracentesis (Evaluating Bleeding Risk Using Laboratory Values)\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":25159,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-6Lr","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26005"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26005"}],"version-history":[{"count":5,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26005\/revisions"}],"predecessor-version":[{"id":28732,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26005\/revisions\/28732"}],"up":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/25159"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26005"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}