1986 Volume 28 Issue 3 Pages 516-522
The present study evaluated the effects of gastric acid levels on intragastric coagulation by thrombin, optimal levels of thrombin which produce the maximum coagulation, and effects of secretin and cimetidine on intragastric pH values. In addition, small amounts of thrombin were repeatedly administered after administration of secretin or cimetidine in patients with acute upper GI tract hemorrhage in order to evaluate its hemostatic effects. Although the coagulative activity of thrombin was almost completely inactivated at pH 1.0, it increased as pH values increased and peaked at pH 6.0 or above . Inactivated thrombin was re-activated when pH values were increased after storage at room temperature for 45 min but not after storage at 37°c for 45 min . A comparison of the coagulative activity of thrombin dissolved in physiological saline at different concentrations indicated that the maximum coagulation is achieved at 5, 000 U/20-40 ml. Intragastric pH values increased to 7.0 and over 45 to 50 min after iv injection of secretin (150 U) or cimetidine (200 mg). The increased pH values were maintained for about 45 and 90 min in the case of secretin and cimetidine, respectively. These results suggested that acute upper GI tract hemorrhage may be effectively treated by oral administration of thrombin in repeated small doses at 3 hr intervals at 5, 000 U/20-40 ml while maintaining high intragastric pH values by administering secretin or cimetidine. This thrombin therapy was then applied in 30 patients with acute upper GI tract hemorrhage. As a result, effective hemostatic effects were obtained in 18 of 19 patients (94.7%) and 9 of 11 patients (81.8%) treated and not treated with endoscopic injection therapy, respectively. These results indicate that this oral thrombin therapy is effective in the treatment of upper GI tract hemorrhage.
