arbaprostil and Postoperative-Complications

A prospective, randomized trial was designed to compare the relative efficacy of 15 (R)-15-methyl prostaglandin E2 with antacid (usually Mylanta II) in 46 patients admitted to a respiratory-surgical intensive care unit. Bleeding was assessed by a modification of the Hemoccult slide test. Three of 22 patients in the antacid group bled, and 12 of 24 patients in the prostaglandin group bled, for a highly significant difference (p = 0.008). Patients in whom prophylaxis failed tended to have a greater number of risk factors. Other prostaglandin analogues that do not require conversion from an inactive to an active form, may be more useful than the agent we studied. Based on currently available data, the hourly titration of the gastric juice to a pH of greater than 3.5 remains the preferred method of prophylaxis for acute bleeding from the stomach in seriously ill patients.

Topics: Aged; Aluminum Hydroxide; Antacids; Arbaprostil; Clinical Trials as Topic; Drug Combinations; Female; Gastric Acid; Gastric Acidity Determination; Gastrointestinal Hemorrhage; Humans; Magnesium Hydroxide; Male; Postoperative Complications; Prospective Studies; Prostaglandins E, Synthetic; Random Allocation; Risk; Simethicone

A 19-yr-old male developed severe hemorrhagic gastritis following three abdominal operations. Treatment with intravenous cimetidine and hourly antacids to maintain his gastric pH above 5 failed to affect gastrointestinal bleeding. Also, peripheral venous vasopressin, propantheline bromide, and glucagon were without effect. Total gastrectomy was considered to control his bleeding. However, since a number of prostaglandin analogs prevent gastric lesions produced by many noxious agents (e.g., aspirin, alcohol, strong acid or alkali, etc.) in animals and humans, the patient was treated with 50 micrograms of 15(R)-15 methyl prostaglandin E2 intragastrically every 6 h for 10 days. To epimerize the 15(R) form to the more active 15(S) form, 50-100 ml of 50-mN HCl was placed into the patient's stomach immediately before each dose. Bleeding ceased within 24 h of the onset of 15(R)-15 methyl prostaglandin E2 therapy and did not recur. The prompt response to 15(R)-15 methyl prostaglandin E2 in combination with hourly antacids in this patient with persistent and severe hemorrhagic gastritis suggests a therapeutic effect and the need for a prospective double-blind clinical trial.

Topics: Abdomen; Administration, Oral; Adult; Arbaprostil; Gastritis; Gastrointestinal Hemorrhage; Humans; Male; Postoperative Complications; Prostaglandins E, Synthetic