The Hematocrit Level in Upper Gastrointestinal Hemorrhage: Safety of Endoscopy and Outcomes
American Journal of Medicine, 10/05/2011

Balderas V et al. – Most patients with upper gastrointestinal hemorrhage presented with a hematocrit less than 30%. Performing endoscopy in patients with a low hematocrit was clearly safe; these data strongly imply that waiting for the hematocrit to reach a certain level before endoscopy is not necessary.

• This cohort study included patients with carefully defined upper gastrointestinal hemorrhage captured in the gastrointestinal Healthcare Registry who underwent esophagogastroduodenoscopy.
• Patients were placed into 2 groups: low hematocrit (<30%) or high hematocrit (>30%).
• Clinical variables and outcomes, including cardiovascular events, intensive care unit transfer, and death, were measured.
• Total of 920 patients meeting entry criteria were identified.

• Baseline features among those with a low and high hematocrit were identical.
• Eight cardiovascular events occurred during or after esophagogastroduodenoscopy, including 5 of 587 (1%) in the less than 30% hematocrit group and 3 of 333 (1%) in the greater than 30% hematocrit group (P=0.29).
• Blood transfusions were more common in the low hematocrit group (74% vs 24%, P<.001).
• However, correlation between the amount of blood transfused and hematocrit level was poor, and the number units of blood transfused was highly variable.
• There was no significant mortality difference in the 2 hematocrit groups.