Endoscopy in the coagulopathic patient

Purpose of review The presence of coagulopathy in patients profoundly affects the performance of gastrointestinal endoscopy. However, the coagulopathy in chronic liver disease (CLD) and therapeutic anticoagulation to lower thromboembolic risk are different. In this review, we briefly discuss the hemostatic alterations in CLD leading to coagulopathy and the periprocedure management of antithrombotic medications in patients needing emergency or elective gastrointestinal endoscopy. Recent findings Prothrombin time (PT) and international normalized ratio (INR) are unreliable measures of bleeding risk and hemostasis in CLD. Therefore, expert opinion advises no preprocedure fresh frozen plasma (FFP) infusion to correct the INR. There has been a proliferation of and increasing use of antithrombotic medications for therapeutic anticoagulation. Their management depends on the gastrointestinal endoscopy procedure bleeding risk, the acuity of the procedure, and the underlying thromboembolic risk of the patient. Summary Cirrhotic coagulopathy features a rebalancing of procoagulant and anticoagulant factors. PT and INR do not accurately measure this rebalanced hemostasis. Thus, expert opinion does not recommend FFP infusion to correct the PT or INR before performing gastrointestinal endoscopy. Management of therapeutic anticoagulation in endoscopy depends on the acuity of the indication, the procedure bleeding risk, and the thromboembolic risk of stopping anticoagulation. At prese...
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: ENDOSCOPY: Edited by Anthony N. Kalloo Source Type: research