CAR/CAIR Practice Guidelines: Periprocedural Management of Patient Bleeding Risk

Abstract

These practice guidelines, developed by the Canadian Association for Interventional Radiology (CAIR) and the Canadian Association of Radiologists (CAR) with input from hematology experts, provide evidence informed, practical recommendations for managing bleeding risk during image guided procedures. Building on the 2019 Society of Interventional Radiology guideline, they streamline decision making around anticoagulation, antiplatelet therapy, laboratory testing, and transfusion thresholds for use across Canadian radiology departments. A systematic review of post 2019 evidence and expert consensus-informed updates to procedural risk stratification and clarified INR and platelet thresholds. The guidance emphasizes that most radiologic procedures carry very low bleeding risk and generally do not require routine laboratory screening or interruption of anticoagulant or antiplatelet medications, while high risk procedures warrant targeted testing and standardized transfusion thresholds, including those tailored for chronic liver disease. Special sections address lumbar puncture, arterial access, and urgent or emergent procedures. Overall, the guideline highlights individualized clinical judgment, avoidance of unnecessary delays or consultations, and careful consideration of transfusion risks, with the goal of promoting streamlined, safe, and consistent care across Canadian imaging practices.