Bleeding Prophylaxis in Bleeding Disorder Patients Undergoing GI Endoscopy
Key Points
Key Points
- Low risk procedures like gastroscopy or colonoscopy without polypectomy have a bleeding risk between 0 and 0.02%.
- In general, a number of variables increases the risk of bleeding, independent of an underlying bleeding disorder, including older age, male gender, polypectomy >7 mm, and colonoscopy performed by a low-volume endoscopist. The continued development of endoscopes and equipment is likely to reduce the bleeding risk further.
- Three recent studies have provided detailed information on best prophylaxis practice for patients with bleeding disorders.
- Infusing to a higher target of 80–100% and using concurrent tranexamic acid pre-procedure should be incorporated in any recommendations as well as infusing for 7–10 days if a high-risk procedure.
Treatment
...atment...
...All Bleeding Disorder...
...re-treatment with antifibrinolytic therapy,*...
...Moderate or Severe Hemophilia or Severe VWD on...
...moving the prophylactic factor dose...
...or the Non-inhibitor Hemophilia a Patient...
Advise infusing with FVIII to goal 80–10...
...hibitor Hemophilia a Patient on Emicizumab...
...pre-procedure 90–120 mcg/kg and repeat t...
...nown DDAVP Responsive Type 1 VWD, Low VWF or Mild...
...ster IN or IV DDAVP 60–90 min pre-proce...
...ic Variceal Ligation or Hemorrhoidectomy...
...pre-dose and continue to infuse daily × 7 days.67...
...ld Platelet Function Disorders...
...IN/IV DDAVP 60–90 min pre-procedure and repeat...
...re Platelet Function Disorders (Glanzmann Thromba...
...ster rVIIa 90–120 mcg/kg then q2...
...merican Society of Gastrointestinal Endosc...
...Procedures Diagnostic endoscopy (EGD, co...
...r Risk Procedures Polypectomy Biliary o...