Hemostatic powder can help stanch acute variceal bleeding

Last Updated: 2018-06-01

By Reuters Staff

NEW YORK (Reuters Health) - Early application of hemostatic powder improves clinical and endoscopic hemostasis in cirrhotic patients with acute variceal bleeding (AVB), researchers report.

Hemospray is a hemostatic powder from Cook Medical that becomes cohesive and adhesive upon contact with moisture and provides a mechanical barrier that covers the bleeding site, achieving rapid hemostasis. It has been reported to be useful in emergency management of AVB as a bridge to more definitive endoscopic therapy.

Dr. Mostafa Ibrahim and colleagues from Erasme Hospital in Brussels and Theodor Bilharz Research Institute in Cairo investigated whether the addition of Hemospray to classical medical and endoscopic therapy improved outcomes in their study of 86 patients presenting with liver cirrhosis and a first episode of severe AVB.

Patients randomized to the intervention group received Hemospray application during an immediate endoscopy within two hours, followed by early elective endoscopy on the next day. Patients randomized to the control group had early elective endoscopy on the next day. Both groups received initial treatment with the vasoactive drug octreotide.

In the intervention group, 38 of 43 patients achieved clinical hemostasis after Hemospray application, and elective endoscopy at a median of 18 hours after admission demonstrated endoscopic hemostasis in all of them. Among the five patients who did not achieve clinical hemostasis, four proceeded directly to definitive endoscopic management and one died before urgent endoscopy could be performed.

Thirteen of 43 patients in the control group did not achieve clinical hemostasis within the first 12 hours and required immediate rescue/emergency endoscopy (12% vs. 30%, P=0.034).

The remaining 30 patients were found to have active bleeding at the time of their early elective endoscopy (median, 16 hours after admission). Various endoscopic methods were used to achieve therapeutic success in all these patients, the team reports in Gut, online May 5.

Five patients in the Hemospray group and 13 patients in the control group experienced rebleeding within the first 12 hours. An additional three patients in the control group (versus none in the Hemospray group) had rebleeding within the first five days after the elective endoscopy.

Thirteen patients in the control group and three patients in the Hemospray group died within the first six weeks.

"In summary, our study introduces a new concept of early, simple, therapeutic procedure that might be offered in places where expertise in endoscopic therapy is not available 24/7 and that would allow to safely bridge to more definitive therapy with a potential effect on overall outcomes (including mortality), the latter still having to be confirmed," the researchers conclude.

Cook Medical, the manufacturer of Hemospray, funded the study and provided an educational grant to Dr. Ibrahim.

Dr. Ibrahim did not respond to a request for comments.

SOURCE: https://bit.ly/2szc3se

Gut 2018.