IR-WIN 2.0
Interventional Radiology Withdrawal Instruction
Decision support tool for managing anticoagulants, antiplatelets and laboratory targets based on the bleeding risk of the specific procedure.
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About IR-WIN
IR-WIN (Interventional Radiology Withdrawal Instruction) is a web-based decision-support tool that helps interventional radiologists and referring clinicians plan the periprocedural management of anticoagulant, antiplatelet and NSAID therapy.
Select the procedure and the medication: IR-WIN classifies the procedure by bleeding risk and returns when to withhold the drug before the procedure, when to resume it afterwards, and the laboratory targets (haemoglobin, platelet count, INR) for that risk category.
Recommendations are derived from the CIRSE Standards of Practice on peri-operative anticoagulation management (2021) and from Abbas et al. (2021). For angiography, neuroangiography and venoplasty IR-WIN deliberately applies the high-risk profile, and for spinal and epidural procedures it adds a neuroaxial platelet threshold.
For anticoagulants, the corresponding CIRSE 2021 recommendation is displayed next to each result, so that any difference between the two sources is immediately visible.
For apixaban, rivaroxaban and dabigatran, the withholding interval before high-risk procedures is adjusted to the creatinine clearance; a Cockcroft–Gault calculator is included. Acenocoumarol, which is not covered by Abbas et al., follows CIRSE 2021.
For every antiplatelet and anticoagulant, a reminder summarises the thrombotic risk of withholding therapy and the patients in whom bridging should be considered.
Procedures covered
LOW RISK CATEGORY
- Venography
- PICC insertion
- Central lines (tunnelled / port)
- IVC filter (standard technique)
- Gonadal vein embolisation
- Transjugular liver biopsy
- Superficial interventions (biopsy / FNA / abscess)
- Lymphocele drainage
- GI tract stenting
- Catheter exchange / removal
- Ultrasound-guided thoracentesis / paracentesis
- Joint aspiration / injection
- Facet joint block
- MSK extremity core biopsies
- Embolisation (fibroid / prostate / TAE)
- Dialysis access (fistulogram / plasty)
HIGH RISK CATEGORY
- TIPSS
- Complex IVC filter removal
- CNS interventions
- Aortic stent grafting
- Cholecystostomy / gastrostomy
- Organ biopsies (liver / lung / renal)
- Biliary interventions / PTC (new access)
- Nephrostomy / nephrolithotomy
- Deep biopsies / drainages
- Thermal ablation
- Vertebroplasty / kyphoplasty
- Spinal biopsy
- Lumbar puncture / epidural injections
- Portal venous interventions
- Venoplasty and venous reconstruction
- Angiography ± angioplasty
- Neuroangiography
Medications covered
Antiplatelets
- Aspirin (Cardioaspirin)
- Clopidogrel (Plavix)
- Ticlopidine (Ticlid)
- Prasugrel (Efient)
- Ticagrelor (Brilique/Brilinta)
- Abciximab (ReoPro)
Anticoagulants
- Warfarin (Coumadin)
- Acenocoumarol (Sintrom)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Edoxaban (Lixiana/Savaysa)
- Dabigatran (Pradaxa)
- Enoxaparin (Clexane/Lovenox)
- LMWH – therapeutic dose
- LMWH – prophylactic dose
- Unfractionated heparin (UFH)
- Fondaparinux – prophylactic dose (Arixtra)
- Fondaparinux – therapeutic dose (Arixtra)
NSAIDs / Analgesics
- Diclofenac (Voltaren)
- Ibuprofen (Brufen/Advil)
- Ketorolac (Toradol)
- Naproxen (Naprosyn)
- Piroxicam (Feldene)
- Indomethacin (Indoxen)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Oxaprozin (Daypro)
What's new in version 2.0
- Separate English and Italian pages.
- New medications: edoxaban, fondaparinux (prophylactic and therapeutic dose) and acenocoumarol.
- For apixaban, rivaroxaban and dabigatran, the withholding interval before high-risk procedures can be refined by creatinine clearance, with a built-in Cockcroft–Gault calculator.
- The CIRSE 2021 recommendation is shown next to every anticoagulant result.
- Thrombotic-risk reminder, including the patients in whom bridging should be considered.
- Search for procedures and medications by name, abbreviation or brand name, with tolerance for typing errors.
- The values for the medications already included in version 1.1 have not been modified; for apixaban, rivaroxaban and dabigatran, the intervals for reduced renal function from the same source have been added.
Important
IR-WIN is intended for qualified healthcare professionals only. It does not replace clinical judgment, institutional protocols or patient-specific assessment (renal function, thrombotic risk, comorbidities).