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PubMed1993

Comparison of thrombin active site and exosite inhibitors and heparin in experimental models of arterial and venous thrombosis and bleeding.

Different pharmacological approaches to thrombin inhibition were compared for their effects on thrombosis and bleeding time in anesthetized rats. Thrombosis was induced in the carotid artery by transmural vessel injury and in the vena cava by partial blood flow stasis combined with mild endothelial disruption. Small mesenteric arteries were punctured with a hypodermic needle to measure the bleeding time. Dose-response relationships were determined with a thrombin active site inhibitor, N-methyl (GYKI 14,766); a thrombin exosite inhibitor, succinyl-Phe-Glu-Pro-Ile-Pro-Glu-Glu-Tyr-cyclohexylalanine-Gln (BMS 180,742); and heparin. BMS 180,742 interferes with fibrinogen binding to the thrombin exosite but, unlike GYKI 14,766, it does not block thrombin's catalytic site. The effects on thrombosis and bleeding time were correlated with ex vivo clotting times using the activated partial thromboplastin time for heparin and the thrombin time for GYKI 14,766 and BMS 180,742. Venous thrombosis was inhibited more than 90% by all three inhibitors at doses that either produced threshold increases or had no effect on bleeding and clotting times. Arterial thrombosis was inhibited 82% by GYKI 14,766 and 63% by heparin but it was not inhibited by BMS 180,742. These antithrombotic activities were accompanied by a maximal activated partial thromboplastin time increase and doubling of the bleeding time with heparin and a maximal thrombin time prolongation and 35% increase in bleeding time with GYKI 14,766. These results suggest that thrombin inhibitors, which act at the active site or exosite or through antithrombin III, are equally efficacious against venous thrombosis but active site inhibitors are the most effective against arterial thrombosis.

Amino Acid Sequence↗
PubMedDate not supplied

Pilot study on the safety and efficacy of desmopressin for the treatment or prevention of bleeding in patients with hematologic malignancies.

BACKGROUND AND OBJECTIVES: Desmopressin is the treatment of choice for patients with von Willebrand's disease and mild hemophilia A. This compound is also useful in other congenital and acquired disorders of hemostasis, reducing the need for blood derivatives with the inherent risks of infections and alloimmunization. The following article presents a pilot study on the safety and efficacy of desmopressin for the treatment or prevention of bleeding in 15 patients with thrombocytopenia associated with hematologic malignancies. METHODS: Cases were consecutively recruited from February to June 1995. Fifteen patients were treated with desmopressin for prevention or treatment of bleeding. Desmopressin was diluted in 100 mL of isotonic saline and infused for 30 minutes. Bleeding time (BT) was carried out using the Simplate II device, making two standardized incisions on the forearm: the mean between the two incisions was recorded. RESULTS: Significant reduction of BT was observed in three out of four patients with myelodysplastic syndrome who were successfully treated for active bleeding or dental extraction. In the remaining patients, the effect of desmopressin on BT was not tested. Nevertheless, in all of them bleeding mainly due to epistaxis or persistent gum oozing was stopped by a single infusion of desmopressin. In three patients, desmopressin infusion had been successfully administered on a different occasion. No side effects were observed. INTERPRETATION AND CONCLUSIONS: Desmopressin could be a safe and immediately effective option for the treatment or prevention of bleeding in selected patients with hematologic malignancies.

Adult↗
PubMed1998

Effects of skin mast cells on bleeding time and coagulation activation at the site of platelet plug formation.

We studied the effects of stimulated skin mast cells on bleeding time and thrombin generation which was measured using prothrombin fragment F 1+2 (F 1+2) and thrombin-antithrombin-III-complex (TAT). In 10 patients with urticaria pigmentosa (chronic cutaneous mast cell accumulation) the mean bleeding time was significantly prolonged in wounds made on urticaria pigmentosa lesions vs. normal skin (460 +/- 34 vs. 342 +/- 27 s, p = 0.005). In 10 atopic subjects skin incisions were made on prick-tested sites 30, 60, 120 and 240 min after administration of an allergen (acute mast cell stimulation), histamine or vehicle. The mean bleeding time was significantly prolonged at all time points, being maximal at 120 min (60% prolonged) in wounds made on allergen-stimulated skin areas (p < 0.01) compared with histamine or vehicle sites. Administration of allergen or histamine lowered the TAT concentration in the bleeding-time blood. Furthermore, TAT and F 1+2 levels in the bleeding-time blood were lower at 60, 120 and 240 min after allergen or histamine application in comparison with samples collected at 30 min. We conclude that skin mast cells can regulate primary hemostasis by prolonging bleeding time and by inhibiting thrombin generation.

Adult↗
PubMed1998

Development and practical use of the new quantitative bleeding time test apparatus.

We have developed a new computerized system for measurement of quantitative bleeding time (QBT) to detect subtle abnormalities of primary hemostasis that are difficult to detect with the standard bleeding time determination. This new apparatus can simultaneously measure the bleeding time (BT; sec), amount of total blood loss (Tv; microl), maximum bleeding rate (Rmax; microl/sec) and bleeding pattern from the bleeding time incision. We have also developed a new holder for the Simplate that enables more consistent incisions and thus improves the reproducibility of the BT test. In this study, the newly developed QBT test was performed in 137 normal healthy volunteers and 10 patients having defined abnormalities of either primary or secondary hemostasis. Comparisons of the standard BT test and our QBT were made in 5 normal subjects and 7 thrombocytopenic patients. Additionally, 6 normal subjects were examined with both tests before and after administration of aspirin. Those results show that our QBT appears to be a more sensitive indicator of primary hemostasis than the standard BT method.

Adolescent↗
PubMed2002

Bleeding and recurrent thrombosis in definite antiphospholipid syndrome: analysis of a series of 66 patients treated with oral anticoagulation to a target international normalized ratio of 3.5.

BACKGROUND: Prolonged anticoagulation is the treatment of choice for patients with thrombosis and the antiphospholipid syndrome. However, there is still debate about the optimum intensity of anticoagulation. METHODS: The study included 66 patients with antiphospholipid syndrome (Sapporo criteria) and previous thrombosis. All were receiving oral anticoagulation to a target international normalized ratio of 3.5. Every patient was individually interviewed to recall major bleeding and thrombotic episodes during the previous 12 months. RESULTS: Patients were mainly women and white. The rate of major bleeding was 6 cases per 100 patient-years (95% confidence interval [CI] 1.6-15.0). The rate of intracranial bleed was 1.5 per 100 patient-years (95% CI, 0.04-8.4). None of the bleeding episodes was fatal. The rate of thrombotic recurrences was 9.1 cases per 100 patient-years (95% CI, 3.3-19.6). Most recurrences took place in the same vascular bed as the original thrombosis. Age, time receiving anticoagulant therapy, primary vs secondary antiphospholipid syndrome, positivity for anticardiolipin antibodies, positivity for lupus anticoagulant, previous arterial thrombosis, previous stroke, previous venous thrombosis, and previous thrombocytopenia were not predictive of bleeding events. However, the risk of thrombotic recurrences was independently higher in patients who were receiving anticoagulation for longer periods. CONCLUSIONS: The risk of intracranial and fatal bleeding in patients with definite antiphospholipid syndrome and previous thrombosis treated with oral anticoagulation to a target international normalized ratio of 3.5 is similar than in groups of patients treated to lower target ratios. The risk of thrombotic recurrences, even during anticoagulation, was high. Most recurrences took place in the same territory as original thromboses.

Adolescent↗
PubMed2003

Early predictors of severity in acute lower intestinal tract bleeding.

BACKGROUND: Identification of high-risk patients with lower intestinal tract bleeding (LIB) is challenging, and prognostic factors have not been clearly defined. The aim of this study was to determine risk factors for severe acute LIB. METHODS: A total of 252 consecutive patients admitted with acute LIB were identified. Data were collected on 24 clinical factors available in the first 4 hours of evaluation. The outcome was severe bleeding, which was defined as continued bleeding within the first 24 hours of hospitalization (transfusion of > or = 2 units of blood and/or hematocrit decrease of > or = 20%) and/or recurrent bleeding after 24 hours of stability (additional transfusions, further hematocrit decrease of > or = 20%, or readmission for LIB within 1 week of discharge). RESULTS: Severe LIB occurred in 123 patients (49%). Independent correlates of severe bleeding were as follows: heart rate, > or = 100/min (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.78-7.57); systolic blood pressure, < or = 115 mm Hg (OR, 3.45; 95% CI, 1.54-7.72); syncope (OR, 2.82; 95% CI, 1.06-7.46); nontender abdominal examination (OR, 2.43; 95% CI, 1.22-4.85); bleeding per rectum during the first 4 hours of evaluation (OR, 2.32; 95% CI, 1.28-4.20); aspirin use (OR, 2.07; 95% CI, 1.12-3.82); and more than 2 active comorbid conditions (OR, 1.93; 95% CI, 1.08-3.44). CONCLUSION: Clinical data available on initial evaluation can be used to identify patients at risk for severe LIB, who may benefit most from urgent intervention.

Aged↗
PubMed1975

Electrocoagulation of bleeding in the upper part of the gastrointestinal tract: a preliminary experimental clinical report.

Electrocoagulation of gastric or esophageal bleeding sites was evaluated in dogs using a flexible suction coagulator electrode passed through the endoscope using an electrocautery unit (Cameron-Miller model 80-7910). Acute and chronic coagulation studies in 25 dogs showed that electrocoagulation of both the esophageal and gastric mucosa was safe at an electrocautery unit setting of 5 for three to five seconds. This level of coagulation was successful in stopping bleeding created from actively bleeding esophageal and gastric mucosal defects by taking multiple large biopsy specimens. Based on these data, six patients with active bleeding gastric lesions have undergone mucosal coagulation. This successfully stopped the bleeding initially in all six patients; two patients rebled and required operative intervention within 48 hours. Further clinical evaluation is being implemented to determine its clinical role in the treatment of bleeding in the upper part of the gastrointestinal tract.

Adult↗
PubMed1980

Prevention of upper gastrointestinal bleeding in burn patients: a role for 'elemental' diet.

In a retrospective study, the role of the elemental diet in preventing upper gastrointestinal (GI) bleeding was evaluated in 146 severely burned patients. The patients were divided into two groups. Group A consisted of 77 patients with 20% to 80% body-surface-area burns who received the usual diet. Group B consisted of 69 patients with similar-sized burns receiving Vivonex as the elemental diet. In group A, the incidence of upper GI bleeding was 44%, major upper GI bleeding was 30%, and two patients required surgery. The incidence of upper GI bleeding in group B was 20%, major upper GI bleeding was 3%, and no patients required surgery. Group A had 55% mortality, and group B, 38% mortality. Vivonex was associated with a noticeable decrease in major upper GI bleeding in severely burned patients, and unlike antacid and cimetidine therapy, contributed concomitantly to increased caloric intake.

Adolescent↗
PubMed1983

Conservative treatment of bleeding stomal varices.

We treated seven cases of bleeding stomal varices and reviewed the literature. The average survival time of conservatively treated patients was 3.9 years. In many cases, other stigmata of liver disease later develop, such as pancytopenia, hepatic encephalopathy, and esophageal varices. Death from stomal bleeding is rare, and such bleeding can usually be controlled by local pressure, direct ligation, or parastomal varices. Death is usually from hepatic failure rather than bleeding per se, and there is no evidence that portosystemic shunting prolongs survival. Conservative therapy is preferable to portosystemic shunting, except when there are bleeding esophageal varices or when bleeding cannot be controlled by local measures.

Adolescent↗
PubMed1997

Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis.

OBJECTIVES: To evaluate the efficacy of arterial embolization (EMB) in the management of bleeding pancreatic pseudocysts or pseudoaneurysms and to assess the possible indication for secondary surgery. DESIGN: Retrospective review with a mean follow-up of 60 months (range, 18-125 months). SETTING: Tertiary care center, university hospital. PATIENTS: The medical records of 14 patients who were referred to the hospital with bleeding pancreatic pseudocysts and/or pseudoaneurysms related to chronic pancreatitis, between 1983 and 1994, were reviewed. The clinical presentation was major bleeding in 10 patients (gastrointestinal or intraperitoneal) and chronic signs in 4. INTERVENTION: Celiac and superior mesenteric angiography with EMB attempt in all patients. MAIN OUTCOME MEASURES: The immediate effect on bleeding and the long-term safety of arterial EMB. RESULTS: Embolization failed in 3 patients and surgery was needed (1 patient died). Embolization was successful in 11 patients, but 2 complications occurred (duodenal necrosis and aortic thrombosis) (1 patient died). Among the 10 patients whose bleeding stopped, an intentional pancreatectomy was performed 4 times (all patients are alive). The 6 other patients did not undergo a further pancreatic operation due to unfavorable local or general condition. None of them had recurrent bleeding, 3 of them died later of extrapancreatic diseases. Overall, early mortality was 14%, with deaths occurring only in unsuccessful or complicated EMB cases. CONCLUSIONS: The immediate effectiveness of arterial EMB is undeniable but depends on the expertise of the radiologist. When EMB is successful, further surgery should be reserved for patients in good general condition who have other complications of chronic pancreatitis that are not amenable to minimally invasive techniques.

Adult↗
PubMed1997

The contact bleeding sign of nasopharyngeal carcinoma.

BACKGROUND: The nasopharynx has lymphoepithelium frequently resulting in mucosal irregularities. Therefore, it is often difficult by mere inspection to clinically differentiate nasopharyngeal carcinoma (NPC) from normal tissue. The present study aimed to determine if contact bleeding could be used as a reliable sign to help differentiate the two. METHODS: Fifty consecutive Chinese adult patients with mucosal masses in the nasopharynx suspicious of being NPC were studied. Contact bleeding, if present, was elicited with a swab stick and viewed with a nasal endoscope. Each mass was then biopsied and examined histologically. RESULTS: Twenty-one patients were histologically proven to have NPC and all had contact bleeding (sensitivity rate of 100%). Of those patients who did not have NPC, 10 had contact bleeding (specificity rate of 65.5%) but 90.0% of them exhibited signs and/or symptoms of rhinosinusitis. After the rhinosinusitis was successfully treated, the masses either resolved or exhibited no further contact bleeding. CONCLUSIONS: Illiciting contact bleeding on masses in the postnasal space is inexpensive, safe, and easy. In many cases, it helps the clinician decide if certain masses warrant biopsies to exclude NPC.

Adult↗
PubMed2000

Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding.

BACKGROUND: The decline in circulating oestrogen around the time of the menopause often induces unacceptable symptoms that affect the health and well being of women. Hormone replacement therapy (both unopposed oestrogen and oestrogen and progestogen combinations) is an effective treatment for these symptoms. In women with an intact uterus, unopposed oestrogen may induce endometrial stimulation and increase the risk of endometrial hyperplasia and carcinoma. The addition of progestogen reduces this risk but may cause unacceptable symptoms, bleeding and spotting which can affect adherence to therapy. OBJECTIVES: The objective of this review is to assess which hormone replacement therapy regimens provide effective protection against the development of endometrial hyperplasia and/or carcinoma with a low rate of abnormal vaginal bleeding. SEARCH STRATEGY: Electronic searches for relevant randomised controlled trials of the Cochrane Menstrual Disorders and Subfertility Group Register of Trials, MEDLINE, EMBASE, PsychLIT, Current Contents, Biological Abstracts, Social Sciences Index and CINAHL were performed. Attempts were also made to identify trials from citation lists of review articles and drug companies were contacted for unpublished data. In most cases, the corresponding author of each included trial was contacted for additional information. SELECTION CRITERIA: The inclusion criteria were randomised comparisons of unopposed oestrogen therapy, combined continuous oestrogen-progestogen therapy and sequential oestrogen-progestogen therapy with each other and placebo administered over a minimum treatment period of six months. Trials had to assess which regimen was the most protective against the development of endometrial hyperplasia/carcinoma and/or caused the lowest rate of irregular bleeding. DATA COLLECTION AND ANALYSIS: Twenty three RCTs were identified and five were excluded. The reviewers assessed the eighteen included studies for quality, extracted the data independently and odds ratios for dichotomous outcomes were estimated. Outcomes analysed included frequency of endometrial hyperplasia or carcinoma, frequency of irregular bleeding and unscheduled biopsies or dilation and curettage, and adherence to therapy. MAIN RESULTS: Unopposed moderate or high dose oestrogen therapy was associated with a significant increase in rates of endometrial hyperplasia with increasing rates at longer duration of treatment and follow up. Odds ratios ranged from 5.4 (1. 4-20.9) for 6 months of treatment to 16.0 (9.3-27.5) for 36 months of treatment with moderate dose oestrogen (in the PEPI trial, 62% of those who took moderate dose oestrogen had some form of hyperplasia at 36 months compared to 2% of those who took placebo). Irregular bleeding and non adherence to treatment were also significantly more likely under these unopposed oestrogen regimens with greater effects with higher dose therapy. There was no evidence of increased hyperplasia rates, however, with low dose oestrogen. The addition of progestogens, either in continuous combined or sequential regimens, helped to prevent the development of endometrial hyperplasia and improved adherence to therapy (odds ratios of 3.7 for sequential therapy and 6.0 for continuous therapy). Irregular bleeding, however, was more likely under a continuous than a sequential oestrogen-progestogen regimen (OR = 2.3, 95% CI 2.1-2.5) but at longer duration of treatment, continuous therapy was more protective than sequential therapy in preventing endometrial hyperplasia (OR = 0.3, 95% CI 0.1-0.97). There was evidence of a higher incidence of hyperplasia under long cycle sequential therapy (progestogen given every 3 months) compared to monthly sequential therapy (progestogen given every month). No increase in endometrial cancer was seen in any of the treatment groups during the limited duration (maximum of 3 years) of these trials. (ABSTRACT TRUNCATED)

Endometrial Hyperplasia↗
PubMed2006

Proton pump inhibitor treatment for acute peptic ulcer bleeding.

BACKGROUND: Randomised controlled trials (RCTs) evaluating the clinical effect of proton pump inhibitors (PPIs) in peptic ulcer (PU) bleeding yield conflicting results. OBJECTIVES: To evaluate the efficacy of PPIs in acute bleeding from PU using evidence from RCTs. SEARCH STRATEGY: We searched CENTRAL, The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to November 2004), EMBASE (1980 to November 2004), proceedings of major meetings to November 2004, and reference lists of articles. We contacted pharmaceutical companies and experts in the field. SELECTION CRITERIA: RCTs of PPI treatment (oral or intravenous) compared with placebo or H(2)-receptor antagonist (H(2)RA) in acute bleeding from PU. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data independently, assessed study validity, summarised studies and undertook meta-analysis. The influence of study characteristics on the outcomes was examined by subgroup analyses and meta-regression. MAIN RESULTS: Twenty-four RCTs comprising 4373 participants in total were included. Statistical heterogeneity was found among trials for rebleeding (P = 0.04), but not for all-cause mortality (P = 0.24) or surgery (P = 0.45). There was no significant difference in all-cause mortality rates between PPI and control treatment; pooled rates were 3.9% on PPI versus 3.8% on control (odds ratio (OR) 1.01; 95% CI 0.74 to 1.40). PPIs significantly reduced rebleeding compared to control; pooled rates were 10.6% with PPI versus 17.3% with control treatment (OR 0.49; 95% CI 0.37 to 0.65). PPI treatment significantly reduced surgery compared with control; pooled rates were 6.1% on PPI versus 9.3% on control (OR 0.61; 95% CI 0.48 to 0.78). There was no evidence to suggest that results on mortality and rebleeding were dependent on study quality, route of PPI administration, type of control treatment or application of initial endoscopic haemostatic treatment. PPIs significantly reduced surgery compared with placebo but not when compared with H(2)RA. There was no evidence to suggest that study quality, route of PPI administration or application of initial endoscopic haemostatic treatment influenced results on surgery. PPI treatment appeared more efficacious in studies conducted in Asia compared to studies conducted elsewhere. All-cause mortality was reduced only in Asian studies; reductions in rebleeding and surgery were quantitatively greater in Asian studies. Among patients with active bleeding or non-bleeding visible vessel, PPI treatment reduced mortality (OR 0.53; 95% CI 0.31 to 0.91), rebleeding and surgery. AUTHORS' CONCLUSIONS: PPI treatment in PU bleeding reduces rebleeding and surgery compared with placebo or H(2)RA, but there is no evidence of an overall effect on all-cause mortality.

Acute Disease↗
PubMed2005

Vitamin K for upper gastrointestinal bleeding in patients with liver diseases.

BACKGROUND: Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Several treatments are used for upper gastrointestinal bleeding in patients with liver diseases. However, supplementary interventions are often used as well. One of them is vitamin K administration, but it is unknown whether it benefits or harms patients with liver disease and upper gastrointestinal bleeding. OBJECTIVES: To assess the beneficial and harmful effects of vitamin K for patients with liver disease and upper gastrointestinal bleeding. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2004), which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1, 2004), MEDLINE (1966 to March 2004), EMBASE (1988 to March 2004), and LILACS (1982 to March 2004). Additional randomised trials were sought from the reference lists of the trials found and reviews identified by the electronic searches. SELECTION CRITERIA: We intended to include randomised clinical trials. DATA COLLECTION AND ANALYSIS: We intended to summarise data by standard Cochrane Collaboration methodologies. MAIN RESULTS: We could not find any randomised trials on vitamin K for upper gastrointestinal bleeding in patients with liver diseases. AUTHORS' CONCLUSIONS: We were unable to identify randomised trials on the safety and efficacy of vitamin K for upper gastrointestinal bleeding in patients with liver diseases. The effects of vitamin K need to be tested in randomised clinical trials.

Antifibrinolytic Agents↗
PubMed1983

Randomized controlled trial of injection sclerotherapy for bleeding oesophageal varices--an interim report.

Oesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow-up of 1-35 months. Fifty-three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty-six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical treatments.

Acute Disease↗
PubMed1991

Stools containing altered blood-plasma urea: creatinine ratio as a simple test for the source of bleeding.

The plasma urea:creatinine ratio (U:C ratio) is known to be elevated in cases of upper gastrointestinal bleeding. Almost all patients with haematemesis have upper gastrointestinal (or generalized) bleeding so that in this study we characterized the diagnostic power of the U:C ratio in patients with stools containing altered blood without haematemesis in the hope that this simple laboratory test (used in conjunction, perhaps, with clinical data) might reduce the number of patients subjected to an unrewarding gastroscopy or colonoscopy. Of 76 cases seen in a provincial and a metropolitan hospital, 42 and 34 patients had upper and lower gastrointestinal bleeding, respectively. Fifty-four per cent of those with upper gastrointestinal bleeding and none of those with lower gastrointestinal bleeding had U:C ratios above 110 on admission. However, a discriminating level of 90 is considered to be more suitable, judged by the quadratic uncertainty score. At this level the odds for upper gastrointestinal bleeding were 15:1.

Aged↗
PubMed1996

Risk of further ulcer complications after an episode of peptic ulcer bleeding.

To identify the risk factors for developing recurrent ulcer complications after recovery from an episode of peptic ulcer bleeding 611 patients admitted with peptic ulcer bleeding were studied. Some 557 (91 per cent) were discharged without operation. A total of 22 patients were lost to follow-up and five were excluded as maintenance H2 blockers were required. Of the remaining 530 patients at risk, 169 (32 per cent) developed another complication (166 bleeding, three perforations) over a median follow-up period of 36 months. Patients with duodenal ulcers at the time of bleeding, previous history of peptic ulcer, previous bleeding, history of dyspepsia longer than 3 months, and a short interval between previous ulcer complications and the index bleed were more likely to develop further complications. Sex, age, smoking, coexisting illness, non-steroidal anti-inflammatory drugs intake and time taken to achieve ulcer healing had no predictive value.

Adolescent↗
PubMed1990

A controlled trial of oral propranolol compared with injection sclerotherapy for the long-term management of variceal bleeding.

This trial was carried out to assess the value of propranolol for the prevention of recurrent variceal bleeding in patients with well-compensated cirrhosis. We also compared propranolol therapy to long-term injection sclerotherapy. One hundred and eight patients, in whom the original variceal hemorrhage stopped spontaneously (before diagnostic endoscopy) and without sclerotherapy or surgical intervention, were included. All were Pugh grade A or B; 55% had alcoholic cirrhosis. Patients were chosen randomly to receive oral propranolol (in a dosage to reduce resting pulse rate by 25%) or to undergo long-term injection sclerotherapy. In both groups, episodes of repeat bleeding that did not stop spontaneously were managed with sclerotherapy. Patients considered to have failed propranolol therapy were treated with long-term sclerotherapy. Follow-up ranged from 12 to 64 mo. In the propranolol group, 28 (54%) of the 52 patients had repeat bleeding from varices with a total of 57 episodes; 14 received long-term sclerotherapy. In the sclerotherapy group, 25 (45%) of the 56 patients had repeat bleeding, with a total of 40 episodes (p less than 0.20). On an intention-to-treat basis, the risk of bleeding expressed per patient-month of follow-up was similar for the two groups, at 0.05 and 0.037, respectively. Survival as assessed by cumulative life analysis was also similar, with 55% and 66% alive at 3 yr (p less than 0.40). Stepwise regression analysis of possible factors predicting further bleeding in patients taking propranolol selected only two variables--the pretreatment pulse rate and the extent of pulse-rate reduction in response to propranolol.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗