Endoscopic procedures in patients with disorders of hemostasis
- Patrick S Kamath, MD
Patrick S Kamath, MD
- Professor of Medicine
- Mayo Clinic College of Medicine
Gastroenterologic procedures are commonly performed in patients with abnormal hemostasis. However, there are limited data assessing the bleeding risk of specific procedures in these settings.
This topic will review the bleeding risks associated with endoscopic procedures, the risk of thromboembolic complications associated with various conditions, and the periprocedural management of patients with von Willebrand's disease, hemophilia, renal failure, liver failure, and thrombocytopenia. The management of patients taking anticoagulants or antiplatelet agents is discussed elsewhere. (See "Management of anticoagulants in patients undergoing endoscopic procedures" and "Management of antiplatelet agents in patients undergoing endoscopic procedures".)
The American Society for Gastrointestinal Endoscopy (ASGE) has issued official guidelines based upon the available evidence and consensus opinion . The recommendations in this topic review are consistent with the ASGE guidelines. In addition, this topic review also addresses disorders of hemostasis not covered by the ASGE guidelines. This topic is also addressed in reviews from the American Journal of Gastroenterology and the Journal of the American College of Cardiology, which make similar recommendations [2,3].
PROCEDURE-RELATED BLEEDING RISK
The ASGE classifies the risk of bleeding from endoscopic procedures in patients with normal coagulation status as either high or low (table 1) (see appropriate topic reviews).
●High-risk procedures (risk of bleeding 1 to 6 percent) include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- ASGE Standards of Practice Committee, Acosta RD, Abraham NS, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 2016; 83:3.
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- SOCIETY GUIDELINES
- PROCEDURE-RELATED BLEEDING RISK
- RISK OF THROMBOEMBOLIC COMPLICATIONS
- PATIENTS TAKING ANTICOAGULANTS
- PATIENTS TAKING ANTIPLATELET AGENTS
- INHERITED DISORDERS OF HEMOSTASIS
- von Willebrand disease
- Hemophilia A and B
- ACQUIRED DISORDERS OF HEMOSTASIS
- Renal failure
- Liver failure
- - Causes of coagulopathy
- - Evaluation
- - Treatment
- SUMMARY AND RECOMMENDATIONS