Upper Gastrointestinal Bleeding Assessment

Patient History and Risk Factors

The American College of Gastroenterology recommends documenting the precise timing and character of melena, including color, consistency, frequency, and duration of symptoms, to estimate the severity and acuity of bleeding 1, 2
Patients with a history of cardiovascular disease, such as coronary artery disease, heart failure, or arrhythmias, are at increased mortality risk and may require higher hemoglobin transfusion thresholds 1, 2
The presence of comorbidities, such as chronic kidney disease, particularly in elderly patients on anticoagulation, increases bleeding risk and alters management 3
A history of malignancy, particularly gastric or esophageal cancer, may present with chronic or acute bleeding 4, 5
The National Comprehensive Cancer Network recommends identifying lifestyle factors, such as tobacco use, which impairs ulcer healing and increases gastric cancer risk 4

The American Heart Association recommends documenting all anticoagulants, including warfarin, rivaroxaban, apixaban, and dabigatran, with dosing and timing of last dose, as these dramatically increase bleeding severity and alter management 3
The use of antiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, including over-the-counter aspirin use, should be recorded 3
Recent antibiotic use, particularly amoxicillin-clavulanate, can cause gastric irritation and bleeding 3

Age >65 years, particularly >80 years, dramatically increases mortality risk to approximately 30% in patients >90 years 3
The presence of shock, defined as pulse >100 bpm or systolic BP <100 mmHg, indicates massive bleeding requiring immediate intervention 1, 3
Multiple comorbidities, such as polytrauma, pleural effusion, or recent infections, compound bleeding risk in elderly patients 3