BSG issues guideline on acute lower gastrointestinal bleeding

  • Oakland K & al.
  • Gut
  • 12 Feb 2019

  • curated by Dawn O'Shea
  • UK Medical News
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The British Society of Gastroenterology (BSG) has issued the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB).

Key recommendations include:

  • Stratify LGIB as stable or unstable (shock index >1) and stable bleeds as major or minor.
  • Patients with minor self-terminating bleed and no other indications can be discharged for urgent outpatient investigation.
  • Admit patients with major bleed for colonoscopy.
  • CT angiography (CTA) before endoscopy or radiology in patients with haemodynamic instability after initial resuscitation and/or suspected active bleeding.
  • Immediate upper endoscopy for haemodynamically unstable LGIB if no source is identified by initial CTA.
  • Catheter angiography as soon as possible after positive CTA.
  • In general, emergency laparotomy should not be performed unless every effort has been made to localise bleeding with radiology and/or endoscopy.
  • In stable patients (without a history of cardiovascular disease) requiring transfusion, a threshold of haemoglobin trigger of 70 g/L and Hb concentration target of 70-90 g/L after transfusion should be used.
  • Interrupt warfarin at presentation. In unstable gastrointestinal haemorrhage, reverse anticoagulation with prothrombin complex concentrate and vitamin K.
  • In patients with high thrombotic risk, consider low molecular weight heparin 48 hours after haemorrhage.
  • Permanently discontinue aspirin for primary CVD prophylaxis.
  • Do not routinely stop aspirin for secondary prevention.
  • Do not routinely stop dual P2Y12 receptor antagonist and aspirin therapy in patients with coronary stents.
  • In unstable haemorrhage, continue aspirin if P2Y12 antagonist is interrupted.
  • Interrupting direct oral anticoagulant therapy at presentation. Considering treatment with idarucizumab or andexanet for life-threatening haemorrhage on direct oral anticoagulants.