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Endoscopy in the coagulopathic patient

Kathy Bull-Henry1

  • 1Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.

Current Opinion in Gastroenterology
|July 26, 2019
PubMed

Insights

Managing coagulopathy in chronic liver disease (CLD) and patients on anticoagulation for gastrointestinal endoscopy requires careful consideration of bleeding risks. Standard tests like PT/INR are unreliable in CLD, and FFP is not recommended.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Hematology

Background:

  • Coagulopathy significantly impacts gastrointestinal endoscopy outcomes.
  • Chronic liver disease (CLD) and therapeutic anticoagulation present distinct coagulopathic challenges.
  • Hemostatic alterations in CLD and management of antithrombotic medications are critical for endoscopy procedures.

Purpose of the Study:

  • To review hemostatic alterations in CLD leading to coagulopathy.
  • To discuss periprocedure management of antithrombotic medications for gastrointestinal endoscopy.
  • To differentiate coagulopathy in CLD from therapeutic anticoagulation.

Main Methods:

  • Review of current literature on coagulopathy in CLD and anticoagulation.
  • Analysis of expert opinions on managing antithrombotic medications during endoscopy.
  • Evaluation of the reliability of PT and INR in CLD patients.

Main Results:

  • Prothrombin time (PT) and international normalized ratio (INR) are unreliable for assessing bleeding risk in CLD.
  • Expert opinion advises against preprocedure fresh frozen plasma (FFP) infusion to correct INR in CLD.
  • Antithrombotic medication management hinges on procedure bleeding risk, acuity, and thromboembolic risk.

Conclusions:

  • Cirrhotic coagulopathy involves a rebalanced hemostasis not accurately measured by PT/INR.
  • FFP is not recommended to correct PT/INR before endoscopy in CLD.
  • Management of anticoagulation during endoscopy requires individualized assessment of risks and benefits, pending further clinical studies.
Abstract

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