Updates from June, 2019 Toggle Comment Threads | Keyboard Shortcuts

  • Juri 1:23 pm on June 26, 2019 Permalink | Reply  

    reintroduction after GI bleed Br J Haem 2017 

    general principles of restarting anticoagulation after GI bleed.jpg



    suggested approach to reintroduction after GI bleed Br J Haem 17.jpg


    suggested approach to antiplatelet after GI bleed Br J Haem 17.jpg

    thrombotic risks Br J Haem 17.jpg

    risks for antiplatelet discontinuation.jpg


    Scott MJ, Veitch A, Thachil J. Reintroduction of anti-thrombotic therapy after
    a gastrointestinal haemorrhage: if and when? Br J Haematol. 2017
    Apr;177(2):185-197. doi: 10.1111/bjh.14599. Epub 2017 Mar 8. Review. PubMed PMID:
  • Juri 12:35 pm on June 26, 2019 Permalink | Reply  

    upper GI bleeding: meds 

    upper GI bleed protocol.jpg

  • Juri 6:12 am on June 26, 2019 Permalink | Reply  

    GI Bleeding by Josh Farkas 

    GI Bleeding

  • Juri 10:01 am on June 25, 2019 Permalink | Reply  

    obere GI-Blutung: pearls 

    obere GI blutung NOWTOGO pearls Wehler.jpg

  • Juri 9:28 am on June 25, 2019 Permalink | Reply  

    Blutstillung unter Antikoagulation 

    GoToWebinar 033 blutstillung unter antikoagulation.png

  • Juri 9:02 am on June 25, 2019 Permalink | Reply  

    volumen/blutprodukte bei oberer GIB, Markus Wehler, NOWTOGO 

    GoToWebinar 019 blutprodukte.png

  • Juri 8:59 am on June 25, 2019 Permalink | Reply  

    transfusion in acute anemia 

    GoToWebinar 018 EK Transfusion.png

  • Juri 8:34 am on June 25, 2019 Permalink | Reply  

    Glasgow Blatchford Bleeding Score 



    GoToWebinar 009 Glasgow Blatchford.png

  • Juri 7:56 pm on June 13, 2019 Permalink | Reply  

    AASLD portal hypertensive bleeding 

    Regarding correction of coagulopathy, RCTs of recombinant factor VIIa have not shown a clear benefit, and therefore correcting the international normalized ratio (INR) by the use of fresh frozen plasma or factor VIIa is not recommended, particularly given that INR is not a reliable indicator of coagulation status in cirrhosis.

    No recommendations can be given regarding platelet transfusion in patients with VH.



    Guidance statements

    • PRBC transfusion should be done conservatively, starting to transfuse when the hemoglobin reaches a threshold of around 7 g/dL with the goal of maintaining it between 7 and 9 g/dL.
    • Short‐term (maximum 7 days) antibiotic prophylaxis should be instituted in any patient with cirrhosis and GI hemorrhage.
    • Intravenous ceftriaxone 1 g/24 h is the antibiotic of choice and should be used for a maximum of 7 days (consider discontinuing when hemorrhage has resolved and vasoactive drugs discontinued).
    • Vasoactive drugs (SMT or its analogue, octreotide; VP or its analogue, terlipressin) should be initiated as soon as VH is suspected (Table 4 for recommended doses and schedules).
    • EGD should be performed within 12 hours of admission and once the patient is hemodynamically stable.
    • If a variceal source is confirmed/suspected, EVL should be performed.
    • In patients at high risk of failure or rebleeding (CTP class C cirrhosis or CTP class B with active bleeding on endoscopy) who have no contraindications for TIPS, an “early” (preemptive) TIPS within 72 hours from EGD/EVL may benefit selected patients.
    • For patients in whom an early TIPS is not performed, intravenous vasoactive drugs should be continued for 2‐5 days and NSBBs initiated once vasoactive drugs are discontinued. Rescue TIPS is indicated in these patients if hemorrhage cannot be controlled or if bleeding recurs despite vasoactive drugs+EVL.
    • In patients in whom TIPS is performed successfully, intravenous vasoactive drugs can be discontinued.
  • Juri 10:01 am on May 28, 2019 Permalink | Reply  

    UK guidelines for variceal haemorrhage 



    • Suggestions for resuscitation and initial management
      • Units offering an emergency acute upper gastrointestinal bleeding service should have expertise in VBL, balloon tamponade and management of gastric variceal bleeding (level 5, grade D).

      • Transfuse patients with massive bleeding with blood, platelets and clotting factors in line with local protocols for managing massive bleeding (level 5, grade D).

      • Base decisions on blood transfusion on the full clinical picture, recognising that overtransfusion may be as damaging as undertransfusion. A restrictive transfusion policy aiming for a haemoglobin of 70–80 g/L is suggested in haemodynamically stable patients (level 1b, grade B).

      • Do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable (level 5, grade D).

      • Offer platelet transfusion to patients who are actively bleeding and have a platelet count of <50×109/L (level 5, grade D).

      • Offer fresh frozen plasma to patients who have either:
        • a fibrinogen level of <1 g/L (level 5, grade D), or

        • a prothrombin time (international normalised ratio) or activated partial thromboplastin time >1.5 times normal (level 5, grade D).

      • Offer prothrombin complex concentrate to patients who are taking warfarin and actively bleeding (level 5, grade D).

      • Treat patients who are taking warfarin and whose upper gastrointestinal bleeding has stopped in line with local warfarin protocols (level 5, grade D).

      • There is insufficient evidence for the use of recombinant factor VIIa in acute variceal haemorrhage (level 1b, grade B).





  • Juri 7:30 am on February 11, 2019 Permalink | Reply  

    variceal hemorrhage in cirrhosis 

    variceal hemorrhage _jk.jpg

    sk2 Leitlinie 2017 keine Gerinnungsfaktoren keine Thrombos.jpg

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