Recurrent gastrointestinal bleeding: use of thrombolysis with anticoagulation in diagnosis.
| Autor: | Malden ES; Department of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA., Hicks ME, Royal HD, Aliperti G, Allen BT, Picus D |
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| Jazyk: | angličtina |
| Zdroj: | Radiology [Radiology] 1998 Apr; Vol. 207 (1), pp. 147-51. |
| DOI: | 10.1148/radiology.207.1.9530310 |
| Abstrakt: | Purpose: To determine the safety and diagnostic accuracy of a provocative protocol with heparin and urokinase to induce bleeding and determine the source in patients with chronic gastrointestinal hemorrhage. Materials and Methods: Nine patients had gastrointestinal bleeding from an indeterminate source and had negative results from esophagogastroduodenoscopy, colonoscopy, small-bowel examination, and angiography. Ten provocative bleeding studies were performed prospectively. Patients had no clinical evidence of bleeding within 2 days before the study. Intravenous administration of heparin and urokinase was performed systemically during a 4-hour period while scintigraphy was performed continuously. Mesenteric angiography was performed immediately in patients in whom substantial gastrointestinal bleeding was detected at scintigraphy. Results: The provocative protocol was successful in inducing scintigraphically detectable hemorrhage in four (40%) studies within 4 hours. In two of these four studies, the source of hemorrhage was determined and treated with embolization or surgery. Three (30%) studies demonstrated scintigraphic evidence of hemorrhage only at delayed imaging (8-24 hours after initiation of the study). The remaining three (30%) studies did not show active bleeding. No complications occurred, including hemodynamic instability or uncontrollable decreases in hematocrit. Conclusion: Since this protocol with heparin and urokinase enabled determination of the bleeding source in only two of 10 studies, protocol modifications are necessary before this intervention is used widely. |
| Databáze: | MEDLINE |
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