Mar 12, 2019

In a new study, investigators from the McGill University Health Centre in Canada conducted a retrospective chart review of bleeding disorder patients who had undergone at least one gastrointestinal (GI) endoscopy.

A GI endoscopy is a procedure in which an endoscope, a small flexible tube with a camera, is gently routed through the esophagus to observe the lining of the GI tract. The aim of the McGill researchers was to assess whether, under the proper clinical management, risk with this procedure was still greater in bleeding disorder patients.

Included in the chart review were 48 adults with either hemophilia A or B, factor VII deficiency, factor XI deficiency, or von Willebrand disease (VWD). A total of 104 endoscopies were performed among this group. Specifically, 45.2% occurred in patients with hemophilia A, 38.5% in patients with VWD, 8.7% in patients with factor XI deficiency, 4.8% in patients with hemophilia B, and 2.9% in patients with factor VII deficiency. Periprocedure (occurring soon before, during, or soon after a procedure) prophylactic therapy was administered where deemed appropriate by a physician. Prophylaxis regimens included combinations of plasma-derived or recombinant factor therapy, desmopressin and/or tranexamic acid.  

The primary focus for investigators were patient bleeding rates measured 72 hours after the procedure. While the overall bleeding rate was 0.96%, the rate for hemophilia A patients was 2.2%. The only high-risk endoscopy reported was in combination with colonoscopy, with polypectomy (procedure used to remove polyps), was associated with a bleeding rate of 4.8%. It should be noted that this higher risk also falls within range of bleeding risk for this procedure in the general population.

“To the best of our knowledge, this is the largest study describing patients with inherited bleeding disorders undergoing gastrointestinal endoscopy, concluded the authors. “The bleeding risk is not significantly higher to the general population when haemostatically managed by a team experienced in bleeding disorders.”

The article, “Low Endoscopy Bleeding Risk in Patients with Congenital Bleeding Disorders,” was published in the February 2019 issue of the journal Haemophilia.

Source: Hematology Advisor, March 6, 2019