Natural history of bleeding peptic ulcers with a tightly adherent blood clot: a prospective observation.
BACKGROUND
The natural history of a bleeding peptic ulcer with a tightly adherent blood clot remains uncertain. Controversy exists concerning removal of such blood clots at the bleeding ulcer base. This article presents the natural history of a bleeding peptic ulcer with a tightly adherent clot and defines the characteristics of those requiring aggressive management.


METHODS
Clinical parameters were analyzed to determine the independent predictors of rebleeding in these patients. One hundred one patients with bleeding peptic ulcers and tightly adherent blood clots were enrolled during a period of 12 months.


RESULTS
Twenty-five patients (25%) rebled within 1 month. With a multivariate analysis, we found comorbid illness (odds ratio, 3.41), shock (odds ratio, 3.65), and initial hemoglobin at or below 10 gm/dL (odds ratio, 2.99) to be independent predictors of rebleeding.


CONCLUSIONS
Most patients with a tightly adherent clot in an ulcer have an uneventful course. However, endoscopic therapy may prove to be beneficial in the subset of patients with independent predictors of rebleeding.
Lin
H J
HJ
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Wang
K
K
Perng
C L
CL
Lee
F Y
FY
Lee
C H
CH
Lee
S D
SD
D001777:Blood Coagulation / Q000502:physiology*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000097:blood / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence
D006454:Hemoglobins