Bleeding Prophylaxis in Bleeding Disorder Patients Undergoing GI Endoscopy

Publication Date: March 16, 2020

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 Patients...

...vise pre-treatment with antifibrinolytic ther...


...Severe Hemophilia or Severe VWD on Prophylaxi...

...he prophylactic factor dose to the d...


...or the Non-inhibitor Hemophilia a Pati...

...se infusing with FVIII to goal 80...


...r the Inhibitor Hemophilia a Patien...

...se rVIIa pre-procedure 90–120 mcg/kg and...


...e Known DDAVP Responsive Type 1 VWD,...

...ister IN or IV DDAVP 60–90 min pre-proced...


...Endoscopic Variceal Ligation or Hemorrho...

...nfuse 100% pre-dose and continue to infu...


...ld Platelet Function Disorders...

...ster IN/IV DDAVP 60–90 min pre-proce...


...ere Platelet Function Disorders (Glanzmann Thro...

...ter rVIIa 90–120 mcg/kg then q2h × 2 m...


...rican Society of Gastrointestinal En...

...ocedures Diagnostic endoscopy (EGD, colonoscop...

...isk Procedures Polypectomy Biliary or pancreat...