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
...reatment
...r All Bleeding Disorder...
...eatment with antifibrinolytic therapy,* conti...
...Moderate or Severe Hemophilia or Severe...
...dvise moving the prophylactic factor dose...
...inhibitor Hemophilia a Patient on Emiciz...
...fusing with FVIII to goal 80–100% pre-pr...
...r Hemophilia a Patient on Emicizumab...
...IIa pre-procedure 90–120 mcg/kg and repeat the...
...DAVP Responsive Type 1 VWD, Low VWF...
...IN or IV DDAVP 60–90 min pre-proce...
...Endoscopic Variceal Ligation or Hemorrhoi...
...fuse 100% pre-dose and continue to infuse dail...
...atelet Function Disorders...
...IN/IV DDAVP 60–90 min pre-procedur...
...vere Platelet Function Disorders (Glanzm...
Pre-administer rVIIa 90–120 mcg/kg then q2...
...an Society of Gastrointestinal Endoscopy...
...ocedures Diagnostic endoscopy (EGD, c...
...her Risk Procedures Polypectomy...
Figure 1. Flowchart Summary
...e 1. Flowchart Summary...