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
...eatment...
...eeding Disorder Patients
...e pre-treatment with antifibrinolytic t...
...or Moderate or Severe Hemophilia or Severe...
...g the prophylactic factor dose to the day of the...
...the Non-inhibitor Hemophilia a Patient on...
...se infusing with FVIII to goal 80–100...
...Inhibitor Hemophilia a Patient on Emicizumab...
...e-procedure 90–120 mcg/kg and repeat the same...
...DDAVP Responsive Type 1 VWD, Low VWF or M...
...IN or IV DDAVP 60–90 min pre-procedure and co...
...c Variceal Ligation or Hemorrhoidectomy...
...dose and continue to infuse daily × 7 days.6731...
...atelet Function Disorders...
...IN/IV DDAVP 60–90 min pre-procedure and re...
...or Severe Platelet Function Disorders (Glanzmann T...
...e-administer rVIIa 90–120 mcg/kg then q2...
...rican Society of Gastrointestinal Endoscopy C...
...edures Diagnostic endoscopy (EGD,...
...rocedures Polypectomy Biliary or p...