Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions : A Multicenter, Noninferiority, Randomized Trial.

Abstract

BACKGROUND:

The effectiveness of the hemostatic powder TC-325 as a single endoscopic treatment for acute nonvariceal upper gastrointestinal bleeding is uncertain.

OBJECTIVE:

To compare TC-325 with standard endoscopic hemostatic treatments in the control of active bleeding from nonvariceal upper gastrointestinal causes.

DESIGN:

One-sided, noninferiority, randomized, controlled trial. (ClinicalTrials.gov: NCT02534571).

SETTING:

University teaching hospitals in the Asia-Pacific region.

PATIENTS:

224 adult patients with acute bleeding from a nonvariceal cause on upper gastrointestinal endoscopy.

INTERVENTION:

TC-325 (n = 111) or standard hemostatic treatment (n = 113).

MEASUREMENTS:

The primary outcome was control of bleeding within 30 days. Other outcomes included failure to control bleeding during index endoscopy, recurrent bleeding after initial hemostasis, further interventions, blood transfusion, hospitalization, and death.

RESULTS:

224 patients were enrolled (136 with gastroduodenal ulcers [60.7%], 33 with tumors [14.7%], and 55 with other causes of bleeding [24.6%]). Bleeding was controlled within 30 days in 100 of 111 patients (90.1%) in the TC-325 group and 92 of 113 (81.4%) in the standard treatment group (risk difference, 8.7 percentage points [1-sided 95% CI, 0.95 percentage point]). There were fewer failures of hemostasis during index endoscopy with TC-325 (3 [2.7%] vs. 11 [9.7%]; odds ratio, 0.26 [CI, 0.07 to 0.95]). Recurrent bleeding within 30 days did not differ between groups (9 [8.1%] vs. 10 [8.8%]). The need for further interventions also did not differ between groups (further endoscopic treatment: 8 [7.2%] vs. 10 [8.8%]; angiography: 2 [1.8%] vs. 4 [3.5%]; surgery: 1 [0.9%] vs. 0). There were 14 deaths in each group (12.6% vs. 12.4%).

LIMITATION:

Clinicians were not blinded to treatment.

CONCLUSION:

TC-325 is not inferior to standard treatment in the endoscopic control of bleeding from nonvariceal upper gastrointestinal causes.

PRIMARY FUNDING SOURCE:

General Research Fund to the University Grants Committee, Hong Kong SAR Government.

• Authors: James Y W Lau, Rapat Pittayanon, Andrew Kwek, Raymond S Tang, Heyson Chan, Rungsun Rerknimitr, June Lee, Tiing Leong Ang, Bing-Yee Suen, Yuan-Yuan Yu, Francis K L Chan, Joseph J Y Sung
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 175 Issue 2 Pg. 171-178 (Feb 2022) ISSN: 1539-3704 [Electronic] United States
• PMID: 34871051 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Hemostatics
• Powders

Topics

• Adult
• Gastrointestinal Hemorrhage (etiology, therapy)
• Hemostasis, Endoscopic (adverse effects)
• Hemostatics (therapeutic use)
• Hong Kong
• Humans
• Powders
• Recurrence