Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bleeding”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,621 records · Page 90Linked to original sources
PubMed2006

Long-term postoperative bleeding after dentoalveolar surgery in the pretransplant liver failure patient.

PURPOSE: A retrospective review of a protocol-driven single institutional experience for treatment of pretransplant liver failure patients requiring dentoalveolar procedures for transplant clearance. MATERIALS AND METHODS: Between January 2003 and June 2005, 30 liver failure patients requiring pretransplant dentoalveolar surgery at the University of Michigan Hospital were treated in the Department of Oral and Maxillofacial Surgery/Hospital Dentistry undergoing 35 total procedures. These patients were stratified preoperatively into 3 different "risk" groups (minimal, moderate, high) based on number and complexity of teeth to be extracted as well as any planned adjunctive preprosthetic procedures. RESULTS: Analysis of variance (ANOVA) comparison of groups was conducted, as well as logistic regression analysis and 2-tailed Pearson correlation using chi2 and the Fisher exact test. The only statistically significant (P < .05) predictors of long-term postoperative bleeding were surgeon-defined "risk," the number of simple extractions, and quadrants of alveoplasty. Additional postoperative correlations were found between long-term bleeding and the need for hospital admission as well as the use of blood products for treatment. Model for end-stage liver disease (MELD), preoperative prothombin time (PT), preoperative partial thromboplastin time (PTT), preoperative international normalized ratio (INR), and preoperative platelet count were not statistically significant in predicting postoperative bleeding. Despite a more aggressive protocol for preoperative management of "high risk" patients, 5/10 (50%) experienced prolonged postoperative bleeding, with 3/5 (60%) requiring admission, while 1/5 (20%) experienced significant prolongation of their current inpatient stay. Review of the data showed that 5/9 (56%) of patients with 10 or more simple extractions developed long-term postoperative bleeding, all of whom had been classified in the "high risk" grouping. Admitted patients remained hospitalized an average of 4 days (range of 1-6 days). CONCLUSION: Even with aggressive preoperative management, pretransplant liver failure patients requiring extraction of at least 10 teeth prior to placement on the liver transplant list are at significant risk of long-term postoperative bleeding and hospital admission for its management.

Analysis of Variance↗
PubMed2005

Continuous combined hormone replacement therapy with 1 mg 17beta-oestradiol and 5 mg dydrogesterone (Femoston-conti): endometrial safety and bleeding profile.

OBJECTIVES: The aim of the study was to confirm the endometrial safety and describe the bleeding profile of continuous combined 1 mg 17beta-oestradiol and 5 mg dydrogesterone in post-menopausal women. METHODS: An open, multicentre study was carried out in 290 healthy, non-hysterectomised post-menopausal women receiving oral continuous combined 1 mg 17beta-oestradiol and 5 mg dydrogesterone (Femoston-conti) for 1 year. Aspiration endometrial biopsies were performed at baseline and at the end of the study; those classified as hyperplasia or malignancy were considered treatment failures. RESULTS: Only one woman developed simple hyperplasia without atypia at the end of the study; the treatment failure rate was therefore 0.4%. Cross-sectional analysis showed that the percentage of women without bleeding increased from 71% during the first cycle to around 80% by the end of the study. Approximately 50% of the bleeding episodes occurred in the form of spotting; severe bleeding was rare and only seven women withdrew prematurely from the study due to uterine bleeding. Overall, 41% of the women were amenorrhoeic throughout the study. CONCLUSIONS: Continuous combined 1 mg 17beta-oestradiol and 5 mg dydrogesterone provides excellent endometrial safety and is associated with an acceptable bleeding profile.

Aged↗
PubMed2006

Efficacy of FDA-approved hemostatic drugs to improve survival and reduce bleeding in rat models of uncontrolled hemorrhage.

Several FDA-approved intravenous drugs are used to reduce surgical bleeding. This series of studies tested whether these drugs (aprotinin, desmopressin, tranexamic acid, epsilon-aminocaproic acid) could reduce bleeding due to traumatic injuries in two models of uncontrolled hemorrhage in rats. In the first phase of each study, a nonlethal tail bleeding model was used that incorporated limited fluid resuscitation (lactate Ringer's solution). Four doses of vehicle or the test substance were given successively with bleeding time and blood loss measured after each dose. In the second phase of each study, a lethal liver injury was produced by excising a section of the median lobe (approximately 0.8% of body weight) and an infusion of either vehicle or the test substance was immediately begun. This model included aggressive fluid resuscitation and a severe dilutional coagulopathy. Blood loss, survival time and mortality rate were recorded. Three studies were performed, testing each of the drugs singly and in combination. None of the drugs significantly reduced either bleeding time or blood loss in the tail bleeding model, nor were blood loss, survival time or mortality rate altered in the liver injury model. Taken together, these results suggest that these FDA-approved drugs, when used either singly or in combination, are not efficacious in these models of traumatic uncontrolled hemorrhage.

Aminocaproic Acid↗
PubMed2005

Recombinant activated factor VII in an unselected series of cases with upper gastrointestinal bleeding.

INTRODUCTION: The mortality rate associated with UGI bleeding remains high at 7-14%. Pharmacologic and endoscopic interventions are the current standard treatment, but there are few alternative options should these fail. This study aimed to assess the efficacy and safety of recombinant activated factor VII (rFVIIa) in the rescue treatment of severe upper gastrointestinal (UGI) bleeding. METHOD: Eleven patients (age: 8-64 years) were treated with rFVIIa at 15.0-90 microg/kg to control UGI bleeds. All three pediatric/adolescent cases and four of the eight adults had UGI hemorrhage associated with liver disease; the origins of the bleeds for remaining adults were trauma (n=1), peptic duodenal ulcer (n=1), hemorrhagic gastritis with sepsis (n=1) and pancreatitis (n=1). RESULTS: Bleeding stopped in seven patients and was markedly reduced in two patients, while there was no change in two patients. Coagulation parameters displayed a tendency to improve, and transfusion requirements were reduced in most patients. In total, five patients died within 2 weeks of rFVIIa treatment. In each case, fatality was judged unrelated to rFVIIa treatment. No thromboembolic events occurred. CONCLUSIONS: These results suggest that, even if our data are optimistic, the use of rFVIIa in the treatment of severe UGI bleeding warrants further investigation in prospective, randomized trials.

Adolescent↗
PubMed2006

Low PAI-1 activity in relation to the risk for perioperative bleeding complications in transurethral resection of the prostate.

INTRODUCTION: Low levels of plasminogen activator inhibitor type 1 (PAI-1) have been associated with increased risk for perioperative bleeding in some case reports. The aim of this study was to investigate prospectively whether low PAI-1 activity increases the risk for perioperative bleeding in patients undergoing transurethral resection of prostate, an organ with high fibrinolytic activity. PATIENTS AND METHODS: 62 patients with benign prostatic hyperplasia planned for transurethral resection were included. Blood samples for PAI-1 were taken together with other routine preoperative blood samples 1week before surgery but analyzed after the hospitalization. The intraoperative blood loss was determined by measuring the amount of hemoglobin in the irrigating fluid. The postoperative blood loss was estimated from calculations of hemoglobin mass (Hb mass), which is a product of hemoglobin concentration and blood volume. Hb mass was calculated before surgery and on the day of discharge, and was adjusted for intraoperative blood loss and transfused Hb mass. Bleeding complications were defined as re-operation due to bleeding, more than 40ml intraoperative bleeding/g resected prostatic tissue or postoperative blood loss corresponding to more than 100g of hemoglobin. RESULTS: Bleeding complications were observed in 3 of 4 (75%) patients with low PAI-1 levels, defined as <1U/ml, and in 16 of 58 (28%) patients with PAI-1 levels >1U/ml (P=0.082). After adjustment for resection time, resected prostatic mass and systolic blood pressure this became borderline significant (odds ratio 11.8; 95% confidence interval 1.00-139; P=0.05). CONCLUSION: Low PAI-1 activity may contribute to the risk of bleeding after transurethral resection of the prostate.

Aged↗
PubMed2004

Relationship between platelet count and bleeding risk in thrombocytopenic patients.

Platelets are lost from circulation by 2 mechanisms: senescence and random loss. Approximately 7.1 x 10(3) platelets/microL/d are postulated to be randomly used in maintaining vascular integrity. Thus, in clinically stable patients, major bleeding is unusual unless the platelet count is </=5 x 10(3)/microL. Risk factors for bleeding at higher platelet counts are disseminated intravascular coagulation with contributory clotting factor deficiencies, structural lesions with loss of vascular integrity, and refractoriness to platelet transfusions. Several large studies have documented the safety of lowering the prophylactic platelet transfusion trigger from the previously used 20 x 10(3)/microL to 10 x 10(3)/microL. A few studies have even suggested that a 5 x 10(3)/microL trigger is acceptable. Based on these results, the next step of giving just therapeutic platelet transfusions is being evaluated. In a large retrospective study, the most significant predictor of bleeding was not the patient's platelet count but a history of bleeding in the prior 5 days. These data suggest that attention should be focused on providing aggressive platelet therapy for active bleeding rather than transfusing platelets prophylactically. Therapeutic platelet transfusions have been documented to control bleeding, and mortality rates are not increased when comparing patients receiving therapeutic to that seen in patients receiving prophylactic platelet transfusions.

Clinical Trials as Topic↗
PubMed2006

Successful treatment of gastrointestinal bleeding with recombinant factor VIIa after kidney transplantation in patients with pancytopenia.

Hemostatic disorders can often complicate transplantation procedures. Moreover, antihemmorhagic drugs may not efficiently control bleeding that occurs in such cases. We report on a patient who underwent kidney transplantation complicated by bone marrow aplasia and gastric bleeding who was successfully treated with recombinant activated FVII (Novoseven). In May 2005, a 53-year-old man affected by chronic renal insufficiency underwent kidney transplantation. At the beginning of June, laboratory tests showed progressive reduction in the blood cell count with anemia, granulocytopenia, and thrombocytopenia related to the development of marrow insufficiency. We commenced transfusion therapy and administered hematologic growth factors. On June 3, 2005, the patient underwent surgical procedure to repair the abdominal wall. Two days thereafter, the postsurgical period was complicated by an episode of melena. The patient received additional treatment with packed red cells, platelets, and fresh-frozen plasma. The gastrointestinal bleeding continued until June 9, 2005, when therapy with recombinant activated FVII (Novoseven) was commenced at an initial dose of 90 microgr/kg. The first bolus did not significantly reduce the blood loss; it was therefore administered as a successive bolus at the same dosage that was able to stop bleeding. Endoscopic examination performed the day after showed the absence of the hemorrhagic lesion in the gastric mucosa. In the subsequent days, the need for transfusion was dramatically reduced with no episode of bleeding. At the same time, the laboratory and clinical findings of marrow insufficiency disappeared. Our case report showed that the use of a global antihemorrhagic factor, such as Novoseven, can successfully control gastrointestinal bleeding even in complicated patients despite failure of traditional antihemostatic therapy.

Erythrocyte Count↗
PubMed1997

Is bleeding a predictor of endometrial hyperplasia in postmenopausal women receiving hormone replacement therapy? Menopause Study Group (United States, Italy, Netherlands, Switzerland, Belgium, Germany, and Finland.

OBJECTIVE: We evaluated bleeding as a predictor of endometrial hyperplasia in postmenopausal women receiving conjugated estrogens (Premarin) alone or with medroxyprogesterone acetate. STUDY DESIGN: This study was a retrospective assessment of bleeding and endometrial histologic data gathered during the prospective Menopause Study Group trial. RESULTS: Approximately 20% of women (n = 57) who received unopposed conjugated estrogens for 1 year had endometrial hyperplasia. These women (n = 56) had more bleeding days than did women who did not have hyperplasia (p < 0.001). For users of unopposed conjugated estrogens, the predictive value of amenorrhea to indicate a nonhyperplasia diagnosis was 95%. Irregular bleeding did not appear to be indicative of hyperplasia when continuous or cyclic medroxyprogesterone acetate was added to conjugated estrogens. CONCLUSION: Unanticipated prolonged bleeding in postmenopausal women receiving unopposed estrogen is suggestive of endometrial hyperplasia. Some irregular bleeding is anticipated in women who receive conjugated estrogens plus medroxyprogesterone acetate as they acclimate to therapy, and this was not associated with hyperplasia.

Endometrial Hyperplasia↗
PubMed2004

Focal expression and final activity of matrix metalloproteinases may explain irregular dysfunctional endometrial bleeding.

Irregular dysfunctional bleeding of the endometrium (ie, metrorrhagia without organic lesion) is common in women, whether treated or not with ovarian hormones. Several matrix metalloproteinases (MMPs) become normally expressed and/or activated at menstruation and cause extracellular matrix breakdown. We therefore explored whether episodes of irregular dysfunctional bleeding could be associated with untimely MMP activity. By histology, foci of stromal breakdown were exclusively found in the endometrium of metrorrhagic women at bleeding. In these foci, 1) expression of estrogen receptor-alpha and progesterone receptor was altered; 2) collagenase-1 (MMP-1), stromelysin-1 (MMP-3), and gelatinase B (MMP-9) became detected in stromal cells, together with MMP-9 in neutrophils; and 3) gelatinase A (MMP-2) was more expressed and immunolocalized at the membrane of stromal cells. By biochemistry, endometrial lysates from nonbleeding metrorrhagic patients contained more latent and active MMP-2 and -9 than age-matched controls; at bleeding, collagenase activity, MMP-9, and active MMP-2 were strikingly increased whereas tissue inhibitor of metalloproteinases-1 (TIMP-1) was considerably decreased. As a functional assay, in situ gelatin zymography revealed large areas of gelatinolytic activity only in endometrium of bleeding patients. Altogether, these results strongly suggest that inappropriate focal expression and activation of several MMPs, combined with decreased inhibition, trigger irregular dysfunctional endometrial bleeding.

Adult↗
PubMed2000

Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding.

BACKGROUND: The aim of this study was to evaluate the diagnostic and therapeutic yield of intraoperative enteroscopy in patients with obscure gastrointestinal (GI) bleeding. METHODS: Complete intraoperative enteroscopy was performed in 25 patients with GI bleeding (overt hemorrhage 21, occult blood loss 4). The cause of GI bleeding was unknown before intraoperative enteroscopy in 20 patients and presumed in 5 (colon 4, duodenum 1). RESULTS: Complete inspection of the small bowel was achieved in all cases. Mucosal-based lesions of the small bowel were identified in 16 of the 20 patients in whom the source of bleeding was unknown preoperatively (angiodysplasia 12, other causes 4). These lesions were treated by segmental small bowel resection (15) or medical therapy (1). With a mean 19-month follow-up, the rebleeding rate was 30% (6 of 20), and 2 of them in whom enteroscopy was negative died of massive hemorrhage. Intraoperative enteroscopy was normal in the 5 patients with bleeding of presumed GI origin preoperatively. CONCLUSIONS: Intraoperative enteroscopy remains a valuable tool for exploring obscure GI bleeding in selected patients.

Adult↗
PubMed1993

Impact of endoscopic therapy on outcome of operation for bleeding peptic ulcers.

Since elective surgery for bleeding peptic ulcer disease has declined, the surgical opinion is that patients who undergo emergency operation have more advanced disease and possibly a poorer outcome. We examined current mortality for surgical correction of upper gastrointestinal (UGI) bleeding from peptic ulcer disease. Between July 1, 1986, and December 31, 1990, 1,213 patients had esophagogastroduodenoscopy for UGI bleeding (659 with peptic ulcer disease, 219 with gastroesophageal varices, 152 with esophagitis, 83 with other causes, and 100 with no source found). Of 110 patients with peptic ulcer disease treated by endoscopic methods, bleeding was controlled in 90, and 20 required operation for failed endoscopic control. Another 22 patients had primary operation for exigent bleeding with diagnostic endoscopy only. The overall results in our series compared favorably with two pre-therapeutic endoscopy index series (Nottingham, 1982; University of Pittsburgh, 1982). Our operation rate was 6%, with a mortality rate of 7%, compared with operation rates of 15% to 27%, with mortality rates of 21% to 22% in the historical control series. In conclusion, we found that: (1) endoscopic control of UGI bleeding from peptic ulcer disease has decreased the incidence of operation compared with historical series; (2) overall operative mortality is decreasing; and (3) the major postoperative complication is rebleeding.

Adult↗
PubMed1990

A hepatologist's view of variceal bleeding.

Patients with cirrhosis and esophagogastric varices have a 25% to 33% risk of initial variceal bleeding, a risk of up to 70% for recurrent variceal bleeding, and an associated mortality of up to 50%. Based on a review of prospective randomized trials, control of acute variceal bleeding should involve vasopressin plus nitroglycerin as indicated for minor bleeding episodes, sclerotherapy for more severe bleeding episodes, and staple transection of the esophagus for patients who do not respond to these initial measures. Emergency portasystemic shunt surgery cannot be recommended at this time. For prevention of recurrent variceal hemorrhage, the data support the use of nonselective beta-adrenergic blockers (propranolol or nadolol) for patients with good liver function (Child's class A and B) and the use of chronic sclerotherapy to obliterate esophageal varices for patients with decompensated cirrhosis (Child's class C). Surgical procedures should be reserved for failures of medical management. The use of beta-adrenergic blockers offers the most promise for prevention of initial variceal bleeding.

Acute Disease↗
PubMed1990

Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding.

The aim of this study was to assess the accuracy of technetium 99m-labeled red cell scintigraphy in localizing the site of lower gastrointestinal bleeding. The outcome of 203 patients undergoing technetium 99m-labeled red cell scintigraphy was reviewed, and the scan result was compared with the true site of bleeding. The true site of bleeding was determined by other methods including angiography and surgical pathology. Fifty-two scans (26%) were positive and indicated a specific site of bleeding. A definitive bleeding site was identified in 22 patients by other means and correlated with the technetium scan in only 9 cases. The nuclear scan was incorrect in the remaining 13 cases, implying a localization error of 25% (13 of 52). A subgroup of 19 patients with a positive scan underwent a surgical procedure directed by the nuclear scan. Eight of these 12 patients had incorrect surgical procedures based upon findings of more definitive tests, indicating a surgical error of 42% (8 of 19). We conclude that the technetium 99m-labeled red cell scan's ability to accurately localize the site of lower gastrointestinal bleeding is limited. Furthermore, performing a surgical procedure that relies exclusively on localization by red cell scintigraphy will produce an undesirable result in at least 42% of patients.

Aged↗
PubMed2001

Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on endometrial bleeding.

OBJECTIVE: To evaluate vaginal bleeding profiles with lower doses of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) as continuous combined therapy. DESIGN: The Women's Health, Osteoporosis, Progestin, Estrogen (Women's HOPE) study, a randomized, double-blind, placebo-controlled trial. SETTING: Study centers across the United States. PATIENT(S): Two thousand six hundred seventy-three healthy, postmenopausal women. INTERVENTION(S): Women received CEE, 0.625 mg/d; CEE, 0.625 mg/d, plus MPA 2.5 mg/d; CEE, 0.45 mg/d; CEE, 0.45 mg/d, plus MPA, 2.5 mg/d; CEE 0.45 mg/d, plus MPA, 1.5 mg/d; CEE, 0.3 mg/d; CEE, 0.3 mg/d, plus MPA, 1.5 mg/d; or placebo for 1 year. MAIN OUTCOME MEASURE(S): Bleeding data were analyzed in efficacy-evaluable and intention-to-treat populations. RESULT(S): Cumulative amenorrhea and no bleeding rates were higher with lower doses of CEE/MPA than with CEE 0.625/MPA 2.5. A linear trend between time since menopause and cumulative amenorrhea was observed (P<.05) in all CEE/MPA groups except the CEE 0.45/MPA 1.5 group. The proportion of patients who experienced no bleeding in cycle 1 was 89%, 82%, and 80% in the CEE 0.3/MPA 1.5, CEE 0.45/MPA 1.5, and CEE 0.45/MPA 2.5 groups, respectively. These values were significantly greater than the incidence of no bleeding in the CEE 0.625/MPA 2.5 group (P<.05). CONCLUSION(S): Lower-dose regimens of CEE and MPA produce higher rates of amenorrhea and no bleeding compared with CEE 0.625/MPA 2.5 and may be appropriate for newly menopausal patients.

Amenorrhea↗
PubMed2005

Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding.

BACKGROUND: Approximately two thirds of patients undergoing capsule endoscopy for obscure GI bleeding will have an abnormality found in the small intestine. This report describes 9 patients (4 men, 5 women) of 140 with obscure bleeding in whom a source of their blood loss was found in the stomach or the colon at capsule endoscopy. METHODS: A review was made of a prospective database of 140 consecutive patients undergoing capsule endoscopy for obscure GI bleeding at a single center. Patients with a definite or likely cause of bleeding within reach of conventional upper or lower GI endoscopy were identified. RESULTS: Three patients had gastric antral vascular ectasia and another an inflamed pyloric canal polyp. Two patients had actively bleeding cecal carcinoma, missed at previous colonoscopies. Two others had bleeding cecal angiodysplasia. The final patient had severe nonspecific cecal inflammation. The identification of these lesions was aided by the suspected blood indicator. All patients underwent endoscopic therapy or surgery for their non-small-bowel lesions. CONCLUSIONS: Like push enteroscopy, capsule endoscopy also can identify lesions within reach of conventional endoscopy and colonoscopy. These subsequently can be treated successfully. The reasons why these lesions have been missed are unclear.

Adolescent↗
PubMed2005

Predictive factors of positive findings in patients explored by push enteroscopy for unexplained GI bleeding.

BACKGROUND: The diagnostic yield of push enteroscopy (PE) in patients with unexplained overt GI bleeding is about 30%. The aim of this study was to assess for predictive factors of positive findings. METHODS: A total of 182 patients referred to two endoscopic centers (European Georges Pompidou Hospital [Paris, France] and Erasmus Hospital [Brussels, Belgium]) for unexplained overt GI bleeding (melena [57%], hematochezia [26%], or hematochezia associated with melena [17%]) were included in this retrospective study. Predictive factors associated with positive findings at upper PE were studied by using uni- and multivariate analysis. RESULTS: The overall diagnostic yield of upper PE was 34% (62/182), but lesions were found beyond the second duodenum in 25% of the patients (45/182). Factors significantly associated with positive findings at upper PE were the following. (1) In univariate analysis: the presence of melena, Hb level <7 g/dL, blood transfusion >4 units per patient, chronic renal failure, disorder of hemostasis or effective anticoagulant treatment, history of intestinal arteriovenous malformation, and age > 65 years. (2) In multivariate analysis: chronic renal failure and presence of melena. If only jejunal lesions were considered, chronic renal failure was the only predictive factor associated with positive findings at upper PE in multivariate analysis. The severity of GI bleeding did not reach statistical significance ( p = 0.06). Delay between GI bleeding and PE, number of previous standard endoscopies and previous episodes of bleeding were not associated with positive findings in upper PE. CONCLUSIONS: In patients with unexplained overt GI bleeding, upper PE has a higher diagnostic yield in patients with chronic renal failure and patients with melena (vs. hematochezia).

Adolescent↗
PubMed1986

Nd:YAG laser in treatment of seriously ill patients with gastrointestinal bleeding.

Nd:YAG (neodymium:yttrium aluminum garnet) laser coagulation was used to treat 30 seriously ill patients with massive or prolonged gastrointestinal bleeding. An average of 7.5 units of blood was given prior to Nd:YAG laser treatment. Twenty patients showed no evidence of continued or recurrent bleeding after laser therapy, four patients rebled after 48 hours, three patients rebled within 48 hours, one patient continued to bleed despite the laser treatment but died of an unrelated cause, one patient required immediate surgery because of inability to control bleeding, and one patient died several hours after control of the bleeding. Although six patients died within 10 weeks, no patient exsanguinated. Nd:YAG laser treatment is a useful modality for controlling severe gastrointestinal bleeding in the seriously ill patient.

Aged↗
PubMedDate not supplied

Randomized comparison of endoscopic microwave coagulation and endoscopic sclerosis in the treatment of bleeding peptic ulcers.

We conducted a prospective randomized trial to evaluate the effectiveness and safety of endoscopic microwave coagulation in comparison to endoscopic sclerosis in the treatment of peptic ulcer bleeding. Over 15 months 127 ulcer-bleeding patients with an actively bleeding vessel (N = 21), a non-bleeding vessel (N = 53), oozing hemorrhage (N = 25), or an adherent clot (N = 28) in the ulcer base were randomly assigned during endoscopy to receive treatment with endoscopic sclerosis or with microwave coagulation. There were no significant differences in effectiveness between endoscopic sclerosis and microwave coagulation in any of the assessed parameters: the percentage of patients with major recurrent hemorrhage (5 vs. 12), the percentage who needed emergency surgery (5 vs. 9), the mean (+/- SD) transfusion requirements (0.32 +/- 0.89 vs. 0.78 +/- 1.65), the mean number of hospital days (10.3 +/- 3.5 vs. 10.7 +/- 4.1), and the number of deaths due to bleeding (0 vs. 2) were similar in both groups. No case of perforation occurred in either group. The data suggest that microwave coagulation is as effective and safe as endoscopic sclerosis in the treatment of bleeding peptic ulcers.

Aged↗