Acute Lower GIB Flashcards
Suggest using risk stratification tools (eg: Oakland score </= 8) to identify low-risk patients w/ LGIB who are appropriate for early discharge and outpatient diagnostic evaluation. Risk scores should be used to supplement but not replace clinician judgement.
conditional, low evidence
Suggest reversal of patients who present w/ a life-threatening GIB and have an INR substantially exceeding the therapeutic range. For patients on vitamin K antagonists to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor PCC is preferred to FFP because of the rapidity of INR reduction.
conditional, low evidence
For patients on DOACs, we suggest several for the small subset of patients who present w/ a life-threatening LGIB that does not respond to initial resuscitation and cessation of the anticoagulant alone. For patients requiring reversal, targeted reversal agents (idarucizumab for dabigatran and andexanet alfa for apixaban and rivaroxaban) should be used when available if the DOAC has been taken within the past 24 hrs.
conditional, low evidence
We recommend against administration of antifibrinolytic agents such as tranexamic acid in LGIB.
strong, moderate evidence
We recommend colonoscopy for most patients who are hospitalized w/ LGIB because of its value in detecting a source.
strong, low evidence
Colonoscopy may not be needed in patients where bleeding has subsided and the patient has had a high-quality colonoscopy within 12 months w/ adequate bowel prep showing diverticulosis w/ no colorectal neoplasia.
conditional, very low evidence
Suggest a CT angiography as the initial diagnostic test in patients w/ ongoing hemodynamically significant hematochezia. However, CTA is of low yield in patients w/ minor LGIB or those in whom bleeding has clinically subsided.
conditional, low evidence
For patients hospitalized w/ LGIB requiring a colonoscopy, we recommend performing a non emergent inpatient colonoscopy, as performing an urgent colonoscopy within 24 hours has not been shown to improve clinical outcomes such as rebreeding and mortality.
strong, moderate evidence
When detected, we recommend treatment of diverticular stigmata of hemorrhage w/ through-the-scope clips, endoscopic band ligation, or coagulation.
strong, moderate evidence
We recommend discontinuing non-aspirin NSAIDs after hospitalization for diverticular hemorrhage.
strong, low evidence
We suggest discontinuing aspirin for primary CV prevention after hospitalization for diverticular hemorrhage given the risks of recurrent diverticular hemorrhage.
conditional, low evidence
We suggest continuing aspirin after hospitalization for diverticular hemorrhage for patients w/ an established CV history given the benefits of reducing future ischemic events.
conditional, low evidence
We recommend resuming anticoagulation after cessation of LGIB given that resumption of anticoagulation has been shown to decrease the risks of post bleeding thromboembolism and mortality.
strong, moderate evidence
