Q: What is the targeting lower INR before doing emergent endoscopy in patients with life-threatening upper gastro-intestinal bleed (UGIB)?


Answer: 3

In life-threatening UGIB, emergent endoscopy should be done as soon as possible to diagnose and stop the bleed. Studies have shown that upper GI endoscopy can be performed safely with INR less than 3. Also, in patients with cirrhosis INR is not a reliable indicator of coagulopathy because it only reflects changes in procoagulant factors.



Further reading/References:

1. Maltz GS, Siegel JE, Carson JL. Hematologic management of gastrointestinal bleeding. Gastroenterol Clin North Am 2000; 29:169.

2. ASGE Standards of Practice Committee, Anderson MA, Ben-Menachem T, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70:1060.

3.Wolf AT, Wasan SK, Saltzman JR. Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. Am J Gastroenterol 2007; 102:290.