What is the role of a coagulation profile in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The patient's prothrombin time (PT), activated partial thromboplastin time (PTT), and international normalized ratio (INR) should be checked to document the presence of coagulopathy. The coagulopathy may be consumptive and associated with a thrombocytopenia.

In a retrospective institutional study, multivariate logistic regression revealed that concomitant antiplatelet therapy, timing of esophagogastroduodenoscopy (EGD) within 12 hours of presentation, and INR level were independent predictors of identification of a source of bleeding. [46] At a threshold of INR 7.5 at presentation, the likelihood of finding an endoscopically significant lesion was less than 20%. The investigators indicated that the relationship between INR elevation and identification of a bleeding source or endoscopic intervention at EGD were antiparallel, but regardless of source identification or endoscopic intervention, important clinical outcomes were unchanged. [46]

A platelet count below 50 × 109 cells/L with active acute hemorrhage may warrant a platelet transfusion and fresh frozen plasma in an attempt to replace lost clotting factors.

The coagulopathy could be a marker of advanced liver disease.

Prolongation of the PT based on an INR of more than 1.5 may indicate moderate liver impairment.

A fibrinogen level of less than 100 mg/dL also indicates advanced liver disease with extremely poor synthetic function.


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