Loffroy et al used transcatheter arterial embolization (TAE) to treat patients with severe, acute nonvariceal upper gastrointestinal bleeding. This may fail to control bleeding if certain risk factors are present. The authors are from University of Dijon in France.
Patient selection: severe, acute nonvariceal upper gastrointestinal bleeding after failure of endoscopic therapy
Risk factors for failure of transcatheter arterial embolization:
(1) coagulopathy (INR > 1.5, platelet count < 80,000 per µL or aPTT > 45 seconds)
(2) longer time interval between shock onset and angiography (> 2 days)
(3) greater volume of preprocedural blood transfusion volume (successful 8.9 +/- 6.3 units; failure 15.9 +/- 8.1 units; use > 10 in implementation)
(4) >= 2 comorbidities (malignancy, coronary heart disease, pulmonary embolism, hypertension, severe diabetes mellitus, heart failure, renal failure, cardiac arrhythmias, recent stroke, peripheral arterial disease, recent surgery, cirrhosis)
(5) use of coils as the only embolic agent
Recommendations:
(1) Perform TAE early in the course of bleeding.
(2) Use one or more additional embolic agents (gelatin sponge, cyanoacrylate, microspherical particles) in addition to coils.
(3) Correct any coagulation disorders before and after the procedure.
