From the Research
After a GI bleed, you should typically trend hemoglobin for at least 24 hours after the bleeding has stopped and the patient is hemodynamically stable before considering discharge. For patients with significant bleeds, monitoring for 48-72 hours is often more appropriate to ensure true stability. Serial hemoglobin measurements should be taken at regular intervals (every 6-8 hours initially, then every 12-24 hours as the patient stabilizes) to confirm that levels have plateaued without further transfusion requirements. Before discharge, ensure that the patient has a stable hemoglobin (no drop >1 g/dL over 24 hours), normal vital signs, no orthostatic hypotension, resolution of symptoms, identification and treatment of the bleeding source, and appropriate follow-up arrangements. This monitoring period is crucial because hemoglobin can lag behind actual blood loss, and rebleeding can occur even after apparent stabilization. Additionally, consider the patient's comorbidities, anticoagulation status, and social support when determining the appropriate monitoring duration and discharge timing, as studies have shown that anticoagulation therapy can increase the risk of GI bleeding 1, 2, 3. The most recent and highest quality study on this topic is from 2021, which highlights the importance of anticoagulant reversal in patients with GI bleeding 2. However, the study that most directly addresses the question of monitoring duration is not explicitly stated in the provided evidence, but based on the available information, the recommended monitoring period is still applicable. It's also important to note that the risk of major GI bleeding with new vs conventional oral anticoagulants has been studied, and rivaroxaban was found to be associated with an increased risk of major GI bleeding 3. Overall, the key factors to consider when determining the appropriate monitoring duration and discharge timing are the patient's hemodynamic stability, comorbidities, anticoagulation status, and social support.