How and when should coagulopathies be corrected?
Coagulopathies should be corrected with appropriate transfusions of packed red blood cells or hemostatic agents such as platelets, fresh-frozen plasma, vitamin K, cryoprecipitate, protamine, and recombinant factor VIIa. Institutional guidelines vary, but an INR greater than 2, a PTT greater than 1.5 times normal, or a platelet count less than 50,000/μL are each a relative contraindication for most procedures. Recent Society of Interventional Radiology guidelines offer useful coagulation and transfusion parameters for percutaneous procedures based on low, moderate, and significant risk of bleeding and ease of bleeding detection and controllability. If the patient has a coronary stent, a cardiology consult may be necessary prior to discontinuing antiplatelet agents to avoid stent complications.