Low endoscopy bleeding risk in patients with congenital bleeding disorders

Area of Science:

• Gastroenterology
• Hematology
• Hepatology

Background:

• Congenital bleeding disorders like hemophilia A and B, von Willebrand disease (VWD), factor VII deficiency, and factor XI deficiency increase bleeding risk during invasive procedures.
• An aging population with these disorders necessitates more gastrointestinal (GI) endoscopies.
• Optimal prophylactic treatments and post-GI endoscopy bleeding risks are not well-established.

Purpose of the Study:

• To evaluate the 72-hour post-GI endoscopy bleeding rate in patients with inherited bleeding disorders.
• To compare bleeding risks in this population to the general population.
• To assess the effectiveness of prophylactic treatment regimens.

Main Methods:

• Retrospective chart review of adult patients with hemophilia A or B, VWD, FVII deficiency, and FXI deficiency who underwent GI endoscopy.
• Prophylaxis included plasma-derived or recombinant factors, desmopressin, and/or tranexamic acid.
• Primary outcome was the 72-hour post-procedure bleeding rate.

Main Results:

• 104 endoscopies were performed in 48 patients; hemophilia A and VWD were most common.
• The overall 72-hour bleeding rate was 0.96% (95% CI: 0.17%-5.25%).
• The post-polypectomy bleeding rate in colonoscopies was 4.8% (95% CI: 0.9%-22.7%), similar to high-risk general population rates.

Conclusions:

• This is the largest study on inherited bleeding disorders and GI endoscopy.
• When managed by experienced teams, the bleeding risk is not significantly higher than in the general population.
• Peri-procedure haemostatic management is crucial for patient safety.