Evaluation of the effects of esophageal varicosclerosants on local vascular occlusion and systemic blood coagulation.
The efficacy and safety of the various sclerosants available for esophageal sclerotherapy have not been adequately investigated. In the present study, we experimentally evaluated the effects on local vascular occlusion and systemic blood coagulation of five sclerosants: 5% ethanolamine oleate, 99.5% ethanol, 2% aethoxysclerol, thrombin, and n-butyl-2-cyanoacrylate. The effects were tested after injection into the auricular vein of rabbits. Prothrombin time, activated partial thromboplastin time, plasma fibrinogen level, and peripheral blood platelet count were measured before injection and 5 minutes, 1 hour, 1 day, and 7 days later. Histologic examinations were then made of the auricular vein, lungs, liver, spleen, and kidneys. In the initial period after injection of ethanol or thrombin, fibrinogen level and platelet count were significantly reduced. Except for thrombin, none of the drugs affected prothrombin time or partial thromboplastin time. Local thrombosis took place after the injection of ethanolamine oleate, ethanol, and aethoxysclerol, whereas thrombin injection did not result in local thrombosis or vascular occlusion. Cyanoacrylate produced no local thrombus formation but caused vascular occlusion. Over-dosing of thrombin and ethanol led to sudden death of animals. These findings suggest that it is necessary to assess further the safety of intravascular use of thrombin, that the other drugs seem to be usable, and that careful consideration should be given to the excess use of ethanol in clinical settings. The present animal model may be useful for evaluating various sclerosants, although findings may not be applicable to humans because of differences in vascular size.
Fujiki
K
K
First Department of Internal Medicine, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
Ohkusa
T
T
Tamura
Y
Y
Sato
C
C
D000818:Animals; D001158:Arteries / Q000187:drug effects / Q000473:pathology; D001777:Blood Coagulation / Q000187:drug effects*; D004431:Ear, External / Q000098:blood supply; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D007511:Ischemia / Q000139:chemically induced / Q000473:pathology; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008168:Lung / Q000098:blood supply; D009336:Necrosis; D010976:Platelet Count / Q000187:drug effects; D011517:Prothrombin Time; D011817:Rabbits; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000633:toxicity*; D015911:Sclerotherapy / Q000379:methods*; D013154:Spleen / Q000098:blood supply; D013927:Thrombosis / Q000139:chemically induced* / Q000473:pathology; D014680:Veins / Q000187:drug effects / Q000473:pathology
D012597:Sclerosing Solutions; D005340:Fibrinogen