3-7% per person year risk of GIB on blood thinners

5.8 per 1000 person year

3 fold increased risk compared with general population of those with GIB
take VKA 8-15% and 7% for upper and lower GIB
risk of death not different in patients on warfarin vs off of it in GI bleeders

Endoscopy should not be postponed to correct coagulopathy with supra-therapeutic INR

vit k risk 3/100,000 slow infusion 30 min

- starts to decrease in 2-4 hrs, reversed in 24 hr
- 5-10 mg recommended
- INR< 5 vit K used

PCC based on INR, timing of endoscopy, patient thrombotic risk, use 25-50 IU/kg

Critical GIB, give PCC, then check INR (if INR > 1.5, call hematology), then PCC along with vit
K, repeat INR 6 hrs, monitor for rebound coagulopathy. FFP only if PCC not available.

GIB without hemodynamic compromise. Given vit k, repeat INR. Consider PCC if endoscopy
within 6-12 hours.

FFP 15 ml/kg

Gastric lavage if DOAC’s ingested in 2-3 hr and oral charcoal

Consider 4F-PCC for DOAC

Avoid Vit K or FFP for DOAC

Cardiology consult
- anyone with a stent placed within the year
- anyone on dual anti platelet therapy for CAD
- anyone with STEMI or NSTEMI in last year
- recurrent GI bleed on antiplatelet therapy for secondary prevention
- anyone who underwent placement of TAVR or Watchman in last 6 months