Evaluate baseline patient-specific risk factors from history, physical examination, and chart review |
- Family history of bleeding disorders
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- Physical examination: Signs of easy bruising including petechiae, mucosal bleeding, and ecchymoses
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- Renal and hepatic disease: Order laboratory tests to evaluate coagulation status
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- Evaluate coagulation tests if required (complete blood count, PT, aPTT)
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- Screening for antiplatelet, antithrombotic, or thrombolytic therapy
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- Identify non-ASA NSAID use
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Categorize individual reason for ASA utilization |
- Primary prophylaxis: Absence of established cardiovascular disease or risk factor
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- Secondary prophylaxis: Presence of cardiovascular disease
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Informed decision making involving procedural physician, prescribing medical physician, and patient |
Identify and manage pharmacologic coagulopathies |
- Understand drug elimination and appropriate discontinuation time
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- Recognize other drugs that may alter coagulation (eg, SSRIs, SNRIs)
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Process the anatomical location of procedural intervention into decision making |
- Cervical/thoracic versus lumbar/sacral neuraxial area
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- High-, intermediate-, or low-risk procedures
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Review appropriate radiographic imaging to identify/understand anatomical challenges |
- Cervical, thoracic, lumbar spinal stenoses that alter spinal canal anatomy
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- Epidural fibrosis and significant scar tissue from previous surgical intervention
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Appropriate timing for reinitiation of anticoagulation |
Appropriate postprocedure surveillance and monitoring |