Table 2 Thrombolytic/other agents' use
From: Provocative mesenteric angiography for occult gastrointestinal bleeding: a systematic review
Study (Year) | No. of patients | Heparin/ Vasodilator use (systemic/catheter-delivered) | Thrombolytic use (intra-arterial) | Detected bleed (Positive provocative bleed) | Embolized | Surgery | Complications related to provocative therapy (yes/no) | Recurrent bleed in negative provocation patients | Follow-up (months) | Reason for PMA | Prior negative interventions |
|---|---|---|---|---|---|---|---|---|---|---|---|
1. Johnston (2007) [25] | 1 | Heparin, (Papaverine- intraarterial) | tPA | 1 (100%) | Yes (100%) | No | No | No | 10 | Chronic LGIB | Conventional angiography 1x |
2. Remzi (2003) [24] | 1 | Heparin | tPA | 1 (100%) | No | Yes | No | No | 18 | Recurrent LGIB | Conventional angiography 2x |
3. Ryan (2001) [13] | 17 | Heparin, (Tolazoline-intra-arterial) | tPA | 6 (37.5%)- 8 (50%) | Yes (3/8) | Yes (1/8) | No | Yes (5/8) | 3–34 | Occult LGIB | Red blood cell scintigraphic studies and conventional angiography (n = NR) |
4. Shetzline (2000) [23] | 1 | Priscoline, (Heparin -intravenous) | tPA | 1 (100%) | Yes | No | No | No | 8 | Recurrent GIB of obscure origin | Colonoscopy, EGD, upper endoscopy with small bowel enteroscopy, 99mTc scintigraphy |
5. Kokoroskos (2020) [16] | 23 | Heparin, Nitroglycerine | tPA | 7 (30%) | Yes (n = 4) | Yes (n = 3) | No | Yes (n = 2/16) | - | GIB (upper and lower) | Conventional angiography 1x |
6. Meade (2020) [27] | 1 | Heparin (systemic and also given intravenous) | tPA | 1 (100%) | Yes | No | No | No | 15 | Obscure UGIB | 12 OGDs, 3 colonoscopies, 3 VCEs, 2 enteroscopies, 1 duodenoscopy, 1 endoscopic ultrasound, 2 CT angiograms, MR enterography, and MR cholangiopancreatography |
7. Thiry (2022) [18] | 36 | Nitroglycerin, Heparin (unspecificed) | tPA | 16 (44%) | Yes (100%) | No | No | Yes (n = 12/20, 60%) | 1 | LGIB | Conventional angiography |
8. Wu (2013) [26] | 1 | - | tPA | 1 (100%) | Yes | No | No | No | - | LGIB | Serial angiograms (n = NR) |
9. Zurkiya (2015) [15] | 19 | Heparin, Verapamil/Nitroglycerin | tPA | 5 (26%) | - | Yes | - | - | - | Recurrent GIB of obscure origin | Normal or non-localizing endoscopic and imaging findings, including angiographic findings |
10. Kim (2010) [2] | 36 | Heparin, (Tolazoline/Papaverine-intra-arterial) | tPA (Alteplase) | 11 (31%)- 12 (33%) | Yes (n = 10/11, 92%) | Yes (n = 1/10) | No | Yes (n = 11/25, 44%) | 12 | Recurrent LGIB | Mesenteric angiogram (n = 24/29, mean 1.2 angiograms per patient; range: 1–4) |
11. Widlus (2007) [14] | 9 | - | tPA (Reteplase) | 8 (89%) | Yes (n = 5) | Yes (n = 1) | No | No | 3–44 | Recurrent, massive, LGIB of obscure origin | 3 vessel diagnostic arteriography (1x) |
Total/Averages | 145 | Heparin (9/11) Nitroglycerin (3/11) | tPA (n = 11, 100%) | 59 (40.7%) | 37 (62.7%) | 12 (20.3%) | No (100%) | 30 (34.9%) | 9.5a |  |  |
12. Koval (1987) [10] | 10 | Heparin, Tolazoline | Streptokinase | 8 (80%) | Unclear | Yes (n = 5) | Yes | Unclear | 36 | LGIB | 99tc-labeled red blood scans |
13. Rösch (1982) [28] | 3 | Heparin, Tolazoline | Streptokinase | 3 (100%) | No | Yes (100%) | Yes | Yes (n = 1) | 8–12 | Recurrent LGIB | 1) angiography 1x 2) sigmoidoscopy, colonoscopy 3) angiography 6x |
Total/Averages | 13 | Heparin (2/2) Tolazoline (2/2) | Streptokinase (n = 2, 100%) | 11 (84.6%) | 3 (27.2%) | 8 (72.7%) | Yes (100%) | Yes (33.3%) | 30a |  |  |
14. Malden (1998) [19] | 10 | Heparin | Urokinase | 4 (40%) studies within 4 h, 3 (30%) at 8–24 h after initiation | Yes (n = 1) | Yes (n = 2) | No | Yes (n = 5/10) | 5–35 | LGIB | Esophagogastroduodenoscopy, colonoscopy, small-bowel examination, and conventional angiography (n = NR) |
15. Miller (1999) [22] | 1 | - | Urokinase | 0 (0%) | No | Yes | No | No | - | Obscure GIB | Upper endoscopy, colonoscopy, and small bowel enteroscopy, upper and lower GI and small bowel barium studies, enteroclysis, radionuclide bleeding studies |
16. Bloomfeld (2000) [12] | 7 | Heparin, Tolazoline | Urokinase | 2 (29%) | No | Yes (2/2) | Yes (n = NR) | Yes (n = 1) | 7–34 | Recurrent GIB of obscure origin | Angiography 1x |
17. Cohn (1998) [11] | 5 | Heparin (n = 2) and Tolazoline hydrochloride (n = 1) | Urokinase (n = 1) | 4 (80%) | - | Yes (n = 1) | Yes (n = 1) | - | - | LGIB | Conventional angiography 1x |
18. George (1991) [21] | 1 | Heparin, Vasodilator | Urokinase | 0/3 (0%) | No | Not possible | No | - | - | Recurrent massive GIB of obscure origin | Upper and lower endoscopy, intravenous sulfur colloid and tagged red cell bleeding scans |
19. Glickerman (1988) [20] | 1 | Heparin, Tolazoline | Urokinase | 1 (100%) | No | Yes | Yes | No | 9 | Recurrent LGIB | Angiography 4x |
20. Kariya (2020) [17] | 12 | Heparin(n = 2), Nicardipine(n = 3)/ Alprostadil(n = 1)/ Isosorbide(n = 1) | Urokinase | 6 (50%) | Yes (n = 6) | Yes (n = 1) | No | Yes (n = 2) | - | LGIB | Colonoscopy, conventional angiography (n = NR) |
Total/Averages | 37 | Heparin (6/7) Tolazoline (3/7) | Urokinase (n = 6, 100%) | 20 (54.1%) | 7 (35%) | 7 (35%) | No (85%) | 8 (47%) | 9.5a |  |  |
Totals | 195 | Heparin (17/20) Tolazoline (7/20) Nitroglycerin (3/20) | tPA (145, 64.2%) Streptokinase (13, 6.7%) Urokinase (37, 19%) | 91 (46.7%) | 49 (53.8%) | 27 (29.7%) | 8 (3.5%) | 39/104 (37.5%) | 10.9a | Â | Â |