PHARMACOLOGICAL MANIPULATION OF GASTRIC-JUICE - THROMBELASTOGRAPHIC ASSESSMENT AND IMPLICATIONS FOR TREATMENT OF GASTROINTESTINAL HEMORRHAGE

The impairment of formation and maintenance of a formed fibrin clot co ntributes to the prolonged bleeding and high incidence of rebleeding i n upper gastrointestinal haemorrhage. To investigate the basis for the use of drug therapy in gastric bleeding, this study used thrombelasto graphy to determine the effects of pharmacological manipulation of gas tric juice on coagulation and fibrinolysis. The thrombelastograph is a mechanical device that provides a visual assessment of all stages of coagulation and fibrinolysis. The effects of fresh and pharmacological ly changed gastric juice was assessed after its addition to fresh whol e blood in the thrombelastograph cuvette. Pharmacological manipulation was achieved through alkalisation or through addition of tranexamic a cid, aprotinin, or sucralfate. Fresh gastric juice delayed clot decrea sed maximum clot and stimulated clot lysis. Alkalisation inhibited the lytic effects of fresh gastric juice and improved the induced abnorma lities in coagulation. Tranexamic acid partially inhibited gastric jui ce induced clot lysis but did not exhibit a beneficial effect on coagu lation. Sucralfate, and to a lesser extent aprotinin significantly inh ibited fibrinolysis but exacerbated the detrimental effect of gastric juice on the parameters of coagulation. Alkalisation of gastric juice reduces the adverse effect on coagulation and fibrinolysis. Tranexamic acid, aprotinin, and sucralfate can all reduce or inhibit clot lysis, but the adverse effects on clot formation may potential benefit in th e gastrointestinal bleeding.