This site is intended for healthcare professionals

2693 pages added, reviewed or updated during the last month (last updated: 14/4/2021)

2693 pages added, reviewed or updated during the last month (last updated: 14/4/2021)


Medical search

acute management of gastrointestinal haemorrhage

FREE subscriptions for doctors and students... click here
You have 3 more open access pages.

Seek expert advice and consult local guidelines.

Risk assessment

  • following formal risk assessment scores should be used for all patients with acute upper gastrointestinal bleeding:
    • the Blatchford score at first assessment,
    • and the full Rockall score after endoscopy
  • if a pre-endoscopy Blatchford score of 0 then consider early discharge

Timing of endoscopy

  • unstable patients with severe acute upper gastrointestinal bleeding should be offered an endoscopy immediately after resuscitation
  • all other patients with upper gastrointestinal bleeding should be offered an endoscopy within 24 hours of admission

Resuscitation and initial management

  • transfuse patients with massive bleeding with blood, platelets and clotting factors in line with local protocols for managing massive bleeding
    • base decisions on blood transfusion on the full clinical picture, recognising that over-transfusion may be as damaging as under-transfusion

  • do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable

  • offer platelet transfusion to patients who are actively bleeding and have a platelet count of less than 50 x 10^9/litre

  • offer fresh frozen plasma to patients who are actively bleeding and have a prothrombin time (or international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal
    • if a patient's fibrinogen level remains less than 1.5 g/litre despite fresh frozen plasma use, offer cryoprecipitate as well

  • offer prothrombin complex concentrate to patients who are taking warfarin and actively bleeding

  • treat patients who are taking warfarin and whose upper gastrointestinal bleeding has stopped in line with local warfarin protocols

  • do not use recombinant factor Vlla except when all other methods have failed

 

Proton pump inhibitors

  • do not offer acid-suppression drugs (proton pump inhibitors or H2-receptor antagonists) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding
  • offer proton pump inhibitors to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy

Management of non-variceal bleeding

  • adrenaline should not be used as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding
  • for the endoscopic treatment of non-variceal upper gastrointestinal bleeding, use one of the following:
    • a mechanical method (for example, clips) with or without adrenaline
    • thermal coagulation with adrenaline fibrin or
    • thrombin with adrenaline
  • interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment
  • refer urgently for surgery if interventional radiology is not promptly available

Management of variceal bleeding

  • terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use
  • prophylactic antibiotic therapy should be offered at presentation to patients with suspected or confirmed variceal bleeding
  • oesophageal varices
    • use band ligation in patients with upper gastrointestinal bleeding from oesophageal varices
    • consider transjugular intrahepatic portosystemic shunts (TIPS) if bleeding from oesophageal varices is not controlled by band ligation.
  • gastric varices
    • endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with upper gastrointestinal bleeding from gastric varices
    • TIPS should be offered if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate

Reference:

  1. NICE (August 2016). Acute Upper GI bleeding.

Last reviewed 01/2018

Links: