Biopsy and Interventional Procedure Scheduling Protocol

1. At the time of scheduling a biopsy or other interventional procedure, patients must be screened for use of Coumadin and other anti-coagulants such as Plavix and Lovenox (see below), and must be screened for other known bleeding disorders

2. If the patient is on Coumadin (warfarin), this medication must be discontinued for 5 days before the scheduled procedure, which must be approved by the referring physician. On the day before the biopsy, the patient should have a Coag Panel obtained and the results of this Panel must be made available to the radiologist for review on the morning of the procedure.

3. All patients undergoing deep solid organ biopsy (abdomen, liver, kidney, bone, prostate) must have a Coag Panel drawn before the scheduled biopsy. For “normal” patients (those not on anticoagulants, those without known bleeding disorders, and those without cirrhosis or other chronic liver disease), Coag Panel results from the prior 6 months are acceptable. For any patient undergoing a liver biopsy and for any patient with known cirrhosis or other chronic liver disease, then Coag Panel results from the prior 30 days are acceptable.

4. Unless the patient is on Coumadin, no laboratory tests are required before a superficial organ biopsy (sites that can be manually compressed), such as breast, thyroid, neck, and chest wall.

5. All patients undergoing deep organ biopsies or other interventional procedures must be driven to the imaging center on the day of the procedure.

1. If the patient is undergoing a superficial organ biopsy (breast, thyroid, face, neck and chest wall), venogram, or arteriogram, the patient can undergo the procedure without stopping their medication. Schedulers should document in the on-line notes that the patient is on Plavix. Physicians should consider additional manual compression times in these patients.

2. In patients undergoing deep organ biopsies (lung, liver, abdomen, prostate, bone, etc.), percutaneous drainage procedures, or percutaneous gastrostomy, it is necessary for patients stop their medication for 5 days prior to the biopsy. Because of potentially complex clinical issues that may arise if a patient stops their medication for such a period, scheduling may refer referring physician questions to the radiologists. These patients can be safely biopsied at RSP sites or Scripps Mercy after their medication is stopped. Plavix may be resumed immediately after the procedure.

Because Lovenox has an extremely short half-life, the simplest procedure is for patients not to take their Lovenox dose on the morning of the biopsy or other interventional procedure. Lovenox may be resumed immediately after the procedure.