Human thrombin for the treatment of gastric and ectopic varices

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 41; pp. 5912 - 5917
• Main Authors: McAvoy, Norma C, Plevris, John N, Hayes, Peter C
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 07.11.2012
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brief; Esophageal and Gastric Varices - drug therapy; Esophageal and Gastric Varices - mortality; Female; Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - mortality; Hemostasis, Endoscopic - adverse effects; Hemostasis, Endoscopic - methods; Hemostasis, Endoscopic - mortality; Hemostatics - administration & dosage; Hemostatics - adverse effects; Hemostatics - therapeutic use; Humans; Injections; Male; Middle Aged; Recurrence; Retrospective Studies; Tertiary Care Centers; Thrombin - administration & dosage; Thrombin - adverse effects; Thrombin - therapeutic use; Time Factors; Treatment Outcome; Young Adult; 人凝血酶; 十二指肠; 平均年龄; 持续时间; 治疗; 胃; 道德准则; 静脉曲张; Thrombin; Variceal haemorrhage; Ectopic Varices; Portal hypertension; Gastric varices
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i41.5912

AIM： To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices. METHODS： Retrospective observational study in a Ter- tiary Referral Centre. Between January 1999-October 2005, we identified 37 patients who were endoscopi- cally treated with human thrombin injection therapy for bleeding gastric and ectopic varices. Patient details including age, gender and aetiology of liver disease/ segmental portal hypertension were documented. The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle. All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded. Initial haemostasis rates, rebleeding rates and mortality were catalogued along with the incidence of any immediate compli- cations which could be attributable to the thrombin therapy. The duration of follow up was also listed. The study was conducted according to the United Kingdom research ethics guidelines. RESULTS： Thirty-seven patients were included. 33 patients （89%） had thrombin （250 U/mL） for gastric varices, 2 （5.4%） for duodenal varices, 1 for rectal varices and 1 for gastric and rectal varices. （1） Gastric varices, an average of 15.2 mL of thrombin was used per patient. Re-bleeding occurred in 4 patients （10.8%）, managed in 2 by a transjugular intrahepatic portosys- temic shunt （TIPSS） （one unsuccessfully who died） and in other 2 by a distal splenorenal shunt; （2） Duodenal varices （or type 2 isolated gastric varices）, an average of 12.5 mL was used per patient over 2-3 endoscopy sessions. Re-bleeding occurred in one patient, which was treated by TIPSS; and （3） Rectal varices, an aver- age of 18.3 mL was used per patient over 3 endoscopy sessions. No re-bleeding occurred in this group. CONCLUSION： Human thrombin is a safe, easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.