Upper GI Bleeding: What changes mortality?
- The most important take-home point: 2 large bore IVs. RESUSCITATION.
- A recent RCT NEJM article showed that a restrictive transfusion strategy (Hb < 70) had a survival benefit. There was a significant decrease in rebleeding, rescue procedures, transfusion reactions and mortality compared to a liberal (Hb < 90) strategy
However, patients with massive bleeding or cardiac disease were excluded, and the protocol was violated to transfuse for symptomatic or worsening bleeding (this happened in <10% of patients)
- In patients with cirrhosis and GI bleeding, don't forget the Ceftriaxone! Even if a patient has no ascites or infectious symptoms, there is still a mortality benefit with Abx
GI Bleeding and Dabigatran
Without an antidote, time and supportive treatment is the recommended management strategy. For life-threatening bleeds not amenable to intervention, involving specialists to consider options like dialysis or activated prothrombin complex (FEIBA) may be warranted. There is little to no evidence in this area
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