Joaquim et al identified risk factors for severe bleeding from colonic diverticuli. This can help to identify patients who may benefit from more aggressive management. The authors are from Universidade do Algarve and Centro Hospitalar do Algarve in Faro, Portugal.
Patient selection: lower gastrointestinal tract bleeding from colonic diverticuli
Criteria for severe bleeding - one or both of the following:
(1) need for any red blood cell transfusion
(2) hemodynamic shock (hypotension, tachycardia, syncope, abnormal mental status, etc) on admission
Independent risk factors for severe diverticular bleeding:
(1) age >= 75 years
(2) hemoglobin <= 11 g/dL on admission (more of a manifestation than cause)
(3) bilateral diverticular location
(4) chronic kidney disease
While a high INR (hypocoagulation) on admission was not an independent risk factor for severe bleeding it does increase hemorrhage. The authors recommended that anticoagulant therapy be stopped, especially if the patient has other risk factors for bleeding.
A bleeding recurrence occurred within 1 year in approximately 13% of patients (1 in 8). The authors did not find independent risk factors for recurrent bleeding.
