Safety of endoscopic interventions in patients with thrombocytopenia

• Published in: Gastrointestinal endoscopy Vol. 80; no. 3; pp. 425 - 434
• Main Authors: Krishna, Somashekar G., MD, MPH, Rao, Bhavana B., MD, Thirumurthi, Selvi, MD, Lee, Jeffrey H., MD, MPH, Ramireddy, Srinivas, MD, Guindani, Michele, PhD, Ross, William A., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-09-2014
• Subjects: Adult; Aged; Biopsy; Blood Loss, Surgical; Blood Transfusion - statistics & numerical data; Endoscopy, Digestive System - adverse effects; Female; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - complications; Gastrointestinal Hemorrhage - surgery; Hemostasis, Endoscopic; Humans; Intestinal Polyps - complications; Intestinal Polyps - surgery; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Thrombocytopenia - complications; CTCAE; GIB; OR; CI; PRBC; PPI; odds ratio; proton pump inhibitor; fully conditional specification; platelet count; packed red blood cells; SD; SSRI; selective serotonin reuptake inhibitor; PC; FCS; hematopoietic stem cell transplantation; confidence interval; HSCT; GI bleeding; Common Terminology Criteria for Adverse Events; standard deviation
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.02.023

Background The risk of endoscopic interventions in thrombocytopenia has received little attention in the medical literature. Objective The aim of this study was to assess the safety of endoscopic interventions including evaluation of GI bleeding (GIB) in patients with thrombocytopenia. Design and Setting Retrospective study, tertiary oncology center. Patients and Intervention Review of consecutive endoscopies with preprocedure platelet counts (PCs) of 75 × 103 /μL or lower. Main Outcome Measurements Risk of bleeding with routine endoscopic interventions and transfusion requirement after evaluation of GIB. Results A total of 617 (351 upper, 266 lower [90 colonoscopies]) endoscopies were performed in 395 patients. Forceps-biopsy specimens were obtained in 398 endoscopies (mean ± standard deviation [SD] PC: 38.21 ± 11.7 × 103 /μL) and 45 polypectomies were performed in 17 endoscopies (mean ± SD PC: 39.65 ± 8.53 × 103 /μL). The risk of bleeding was 1.5% (6 of 398 endoscopies) at the biopsy site and 4% (2 of 45 polypectomies) at the polypectomy site. Active GIB (mean ± SD PC: 32.85 ± 4.0 × 103 /μL) was observed in 68 (11% of 617) endoscopies and intervention (mean ± SD PC: 33.68 ± 4.6 × 103 /μL) was performed in 41 procedures. Together, angiodysplasias and ulcers were the most common etiology (51.2% of 41). Hemostasis was achieved in 39 (95.1% of 41) procedures. Comparison of blood transfusions ± 3 days of successful therapy showed a 52% reduction ( P  < .001). By multivariate analysis, a higher aggregate blood transfusion 3 days preceding endoscopy (odds ratio 1.32; 95% confidence interval, 1.16-1.50; P  < .001) predicted endoscopic findings of active GIB. Limitations Retrospective design, single center. Conclusions In the largest endoscopic experience reported in thrombocytopenic patients (Common Terminology Criteria for Adverse Events grade 3 or lower), bleeding caused by standard forceps biopsy and polypectomy (≤10 mm) was minor and easily controlled. Endoscopic therapy for GIB is safe and significantly reduces the packed red blood cell requirement and should be considered in patients with thrombocytopenia in the setting of an appropriate transfusion strategy.