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...
...or All Bleeding Disorder Pa...
...tment with antifibrinolytic therapy,* continue fo...
...derate or Severe Hemophilia or Severe VWD on Proph...
...e moving the prophylactic factor dose to...
...he Non-inhibitor Hemophilia a Patient on Em...
...infusing with FVIII to goal 80–10...
...or Hemophilia a Patient on Emicizum...
...e rVIIa pre-procedure 90–120 mcg/kg and...
...n DDAVP Responsive Type 1 VWD, Low VWF or M...
...or IV DDAVP 60–90 min pre-procedure and co...
...ndoscopic Variceal Ligation or Hemorrhoidec...
...% pre-dose and continue to infuse daily × 7...
...r Mild Platelet Function Diso...
...ister IN/IV DDAVP 60–90 min pre-pro...
...evere Platelet Function Disorders (Glanzman...
...ter rVIIa 90–120 mcg/kg then q2h × 2 more d...
...Society of Gastrointestinal Endoscop...
...cedures Diagnostic endoscopy (EGD, colono...
...isk Procedures Polypectomy Biliary or pa...