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
Treatme...
...All Bleeding Disorder Patients...
...se pre-treatment with antifibrinolytic th...
...r Moderate or Severe Hemophilia or Sever...
...the prophylactic factor dose to the day of th...
...-inhibitor Hemophilia a Patient on...
...e infusing with FVIII to goal 80–100...
...nhibitor Hemophilia a Patient on Emicizumab...
...pre-procedure 90–120 mcg/kg and repeat the same...
...n DDAVP Responsive Type 1 VWD, Low VWF or Mi...
...N or IV DDAVP 60–90 min pre-procedure and consid...
...copic Variceal Ligation or Hemorrhoidectomy...
...re-dose and continue to infuse daily × 7 d...
...ld Platelet Function Disorde...
...N/IV DDAVP 60–90 min pre-procedure and...
...or Severe Platelet Function Disorders (Gla...
...re-administer rVIIa 90–120 mcg/kg then q...
...Society of Gastrointestinal Endoscopy...
Low Risk Procedures Diagnostic endoscopy (EGD...
...k Procedures Polypectomy Biliary o...