Radiology Procedures: Paracentesis (Evaluating Bleeding Risk Using Laboratory Values)

OVERVIEW

An important component of assessing the risk of a paracentesis  procedure is to assess the patient’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 (discussed separately on this page here) should also be taken into consideration.

Evaluating lab values is an important step in determining the risk of a radiology procedure, specifically the risk of bleeding (image source)

For more general information on evaluating bleeding risk for radiology procedures by evaluating laboratory values please refer to this page here.

RISK CLASSIFICATION OF A PARACENTESIS

Most all of the commonly used guidelines characterize a paracentesis as a “low bleeding risk procedure” which in turn informs the laboratory thresholds that should be applied as contraindications to the procedure.

Given that there is more then one guideline, some of them are listed here below to clarify specific recommendations.

2013 ADDENDUM TO SIR CONSENSUS GUIDELINES 

This 2013 addendum to the prior 2009 SIR consensus guidelines makes the following recommendations for a low risk procedure like a paracentesis:

  • Routine laboratory tests: INR/aPTT (platelets not recommended unless risk of thrombocytopenia in the patient)
  • INR value: ≤ 2.0
  • Platelet level: > 50,000/µL
2019 SIR CONSENSUS GUIDELINES 

The 2019 SIR consensus guidelines make the following recommendations for a low risk procedure like a paracentesis:

  • Routine laboratory tests: None (unless the patient is at risk of an elevated INR or thrombocytopenia)
  • INR value: ≤ range from 2.0 – 3.0
  • Platelet level: > 20,000/µL
GUIDELINES FOR SPECIAL PATIENT POPULATIONS

Certain guidelines have specific recommendations for special populations of patients. These are included below:

PATIENTS WITH CHRONIC LIVER DISEASE

The 2019 SIR consensus guidelines 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):

  • Routine laboratory tests: Platelet count, fibrinogen level (NOT INR)
  • INR value: None
  • Platelet level: > 20,000/µL
  • Fibrinogen level: > 100 mg/dL

 

 

Page Updated: 01.09.2020