Recurrent gastrointestinal bleeding: use of thrombolysis with anticoagulation in diagnosis.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Malden
E S
ES
Department of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
Hicks
M E
ME
Royal
H D
HD
Aliperti
G
G
Allen
B T
BT
Picus
D
D
D000328:Adult; D000368:Aged; D000925:Anticoagulants; D002908:Chronic Disease; D005260:Female; D005343:Fibrinolytic Agents; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D006493:Heparin; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D011877:Radionuclide Imaging; D012008:Recurrence; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator