Monitoring
Most patients usually stop bleeding spontaneously before endoscopic evaluation. Serial hemoglobin (Hb) levels after endoscopic therapy should be considered only in patients with a high risk of rebleeding. Blood transfusion (packed RBCs) may be necessary in certain cases (for ongoing bleeding, or low Hb at presentation). Guidelines differ in exact thresholds. The American College of Gastroenterologists recommends transfusion at Hb <7 g/dL, or <8 g/dL in patients with cardiovascular disease (CVD), fluid resuscitation-related hemodilution, or multiple comorbidities.[39] The International Consensus Group was concerned about undiagnosed CVD and suggests a slightly higher transfusion threshold Hb of 8 g/dL.[40] A target of Hb ≥10 g/dL should be aimed for in patients with CVD, while a lower level of Hb 7-9 g/dL is considered appropriate for patients without CVD.[1] Prothrombin time/international normalized ratio (PT/INR) should be monitored, and if prolonged, should be corrected with fresh frozen plasma and/or vitamin K (phytonadione). Associated lesions should be identified during endoscopy and treated accordingly.
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