Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations

In 2012, the Society of Interventional Radiology (SIR) published its first consensus practice guidelines regarding the periprocedural management of coagulation status for percutaneous image-guided interventions (1Patel I.J. Davidson J.C. Nikolic B. et al.Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) EndorsementConsensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.J Vasc Interv Radiol. 2012; 23: 727-736Abstract Full Text Full Text PDF PubMed Scopus (303) Google Scholar), which was subsequently revised in 2013 with a discussion of newer anticoagulant agents (2Patel I.J. Davidson J.C. Nikolic B. et al.Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) EndorsementAddendum of newer anticoagulants to the SIR consensus guideline.J Vasc Interv Radiol. 2013; 24: 641-645Abstract Full Text Full Text PDF PubMed Google Scholar). The present update to both documents incorporates a multidisciplinary approach to the periprocedural management of coagulation status with emphasis on the patient's clinically relevant comorbidities, and will be divided into 2 parts: part I will review classes of anticoagulation medications and clinical considerations common to patients requiring percutaneous image-guided interventions; part II will discuss recommendations. The Standards Division of SIR provides evidence-based clinical practice documents to ensure patient safety and enhance the delivery of patient care. Standards Division members are leaders in the field of interventional radiology from the private and academic sectors of medicine who dedicate the vast majority of their professional time to performing interventional procedures, and, as such, they represent a broad expert constituency of the subject matter under consideration for standards development. Topics for standards document development are solicited through an annual survey that allows SIR members the opportunity to submit topics for consideration. The proposed topics are approved and prioritized by the Executive Council. A recognized expert or group of experts is identified to serve as the principal author or writing group for the document. Additional authors or societies may be sought to increase the scope, depth, and quality of the document depending on the magnitude of the project. An in-depth literature search is performed by using electronic medical literature databases, such as Medline (via PubMed) and The Cochrane Library. A critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. All documents have adopted an updated methodology for evidence grading and assessment of strength of recommendation (Appendixes A and B, available online on the article's Supplemental Material page at www.jvir.org) to fulfill the Institute of Medicine standards for guidelines development. Accepted definitions of the hierarchical classification of evidence, commonly used by systems such as Oxford and Grading of Recommendations Assessment, Development and Evaluation, are included, and an assessment of the strength of recommendation is defined to assist in clinical decision-making (3Guyatt G.H. Oxman A.D. Vist G.E. et al.GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.Br Med J. 2008; 336: 924-926Crossref PubMed Google Scholar, 4OCEBM Levels of Evidence Working GroupThe Oxford 2011 Levels of Evidence.https://www.cebm.net/index.aspx?o=5653Date: 2011Date accessed: May 16, 2018Google Scholar). Similar classification systems are used by other specialty practice societies such as the American College of Cardiology and the American Heart Association (5Jacobs A.K. Anderson J.L. Halperin J.L. et al.The evolution and future of ACC/AHA clinical practice guidelines: a 30-year journey: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.Circulation. 2014; 130: 1208-1217Crossref PubMed Scopus (62) Google Scholar). The level of evidence assessment is used to create the evidence tables that inform the standards documents. For documents that incorporate clinical recommendations, the strength of recommendation is used to denote how well the recommendation is supported by systematic evidence. When the evidence of literature is weak, conflicting, or contradictory, a modified Delphi technique may be used to enhance effective decision-making (6Fink A. Kosecoff J. Chassin M. Brook R.H. Consensus methods: characteristics and guidelines for use.Am J Public Health. 1984; 74: 979-983Crossref PubMed Google Scholar, 7Leape L.L. Hilborne L.H. Park R.E. et al.The appropriateness of use of coronary artery bypass graft surgery in New York State.JAMA. 1993; 269: 753-760Crossref PubMed Google Scholar), and consensus for the parameter is reached when 80% of panelists are in agreement. The draft document is critically reviewed by the writing group and members of the Standards Division by telephone conference call or face-to-face meeting. Comments are discussed by the members of the Standards Division, and appropriate revisions made to create the final document before peer review, approval by the SIR Operations Committee, and journal publication.