RECURRENT GASTROINTESTINAL-BLEEDING - USE OF THROMBOLYSIS WITH ANTICOAGULATION IN DIAGNOSIS

PURPOSE: To determine the safety and diagnostic accuracy of a provocat ive protocol with heparin and urokinase to induce bleeding and determi ne the source in patients with chronic gastrointestinal hemorrhage. MA TERIALS AND METHODS: Nine patients had gastrointestinal bleeding from an indeterminate source and had negative results from esophagogastrodu odenoscopy, colonoscopy, small-bowel examination, and angiography. Ten provocative bleeding studies were performed prospectively. Patients h ad no clinical evidence of bleeding within 2 days before the study. In travenous administration of heparin and urokinase was performed system ically during a 4-hour period while scintigraphy was performed continu ously. Mesenteric angiography was performed immediately in patients in whom substantial gastrointestinal bleeding was detected at scintigrap hy. RESULTS: The provocative protocol was successful in inducing scint igraphically detectable hemorrhage in four (40%) studies within 4 hour s. In two of these four studies, the source of hemorrhage was determin ed and treated with embolization or surgery. Three (30%) studies demon strated scintigraphic evidence of hemorrhage only at delayed imaging ( 8-24 hours after initiation of the study). The remaining three (30%) s tudies did not show active bleeding. No complications occurred, includ ing hemodynamic instability or uncontrollable decreases in hematocrit. CONCLUSION: Since this protocol with heparin and urokinase enabled de termination of the bleeding source in only two of 10 studies, protocol modifications are necessary before this intervention is used widely.