Medical interventions may pose an extra bleeding risk for patients with congenital bleeding disorders, but the level of risk is not well understood for all procedures or in the context of prophylactic therapies. Researchers examined bleeding risk during gastrointestinal endoscopic procedures in this patient population and presented results in a recent issue of Haemophilia.

Patients examined in this retrospective chart review conducted at McGill University Health Centre in Canada were adults (48 patients) with hemophilia A or B, factor VII deficiency, factor XI deficiency, or von Willebrand disease who had undergone at least 1 gastrointestinal endoscopy (104 endoscopies overall). Patients received periprocedure bleeding prophylaxis therapies as appropriate. The primary study outcome was the bleeding rate at 72 hours after endoscopy.

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Among all endoscopies, 45.2% occurred in patients with hemophilia A, 38.5% in patients with von Willebrand disease, 8.7% in patients with factor XI deficiency, 4.8% in patients with hemophilia B, and 2.9% in patients with factor VII deficiency.

The bleeding rate among patients in this study during the 72 hours after endoscopy was 0.96% (95% confidence interval [CI]: 0.17%-5.25%). For hemophilia A, the most commonly represented condition in this study, the rate was 2.2% (95% CI: 0.4%-11.3%).

According to the authors, the 72-hour bleeding rate within the general population following high-risk endoscopies is 0.3% to 10%. Of note, one type of high-risk endoscopy examined in this study, colonoscopy with polypectomy, had a 72-hour bleeding rate of 4.8% (95% CI: 0.9%-22.7%), or 1 out of 21 patients with congenital bleeding disorders. However, this falls within the range of bleeding with high-risk endoscopies reported for the general population. The bleeding rate for all other bleeding disorders was 0%.

In this study population, endoscopy did not significantly increase bleeding risk in patients with congenital bleeding disorders who were receiving proper management. The authors urged further analysis with larger studies to fully ascertain this risk and the effectiveness of prophylaxis therapies.

Reference

1.     Tomaszewski M, Bienz M, Kherad O, et al. Low endoscopy bleeding risk in patients with congenital bleeding disorders [published online February 12, 2019]. Haemophilia. doi: 10.1111/hae.13691