P0590 - Purastat for Hemostasis in Gastrointestinal Bleeding: A Single Center Experience

Sohrab Zand, MBBCh¹, Christopher J. Tricarico, MD², Michael Mintz, MD³, Shamin H. Mahmud, ⁴, Madeleine Mogl, ⁵, David Wan, BS, MD^3
1Cayuga Medical Center, Ithaca, NY; ²Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY; ³Weill Cornell Medicine, New York, NY; ⁴Weill Cornell Medicine-Qatar, Doha, Ar Rayyan, Qatar; ⁵Technical University of Munich School of Medicine, Munich, Bayern, Germany

Introduction: PuraStat is a biocompatible synthetic polypeptide gel that is commonly used to prevent delayed bleeding (DB) secondary to therapeutic endoscopic procedures. It is among a growing number of new products that utilize an extracellular matrix to prevent bleeding. Its use for hemostasis, however, is less clear.

Methods: We present a case series of PuraStat use for the indication of active gastrointestinal (GI) bleeding at a single large tertiary care center. This included both cases of primary GI bleeding and GI bleeding caused by an endoscopic procedure. Cases where PuraStat was used for the indication of bleeding prophylaxis were excluded. Our primary outcome was DB, defined as the need for a repeat endoscopic procedure or a blood transfusion due to gastrointestinal bleeding within 30 days of the index endoscopy.

Results: Eight patients undergoing nine procedures met the inclusion criteria (Table 1). The mean age of the patients was 76 (range 49 to 87). Five of the cases involved hemostasis of primary GI bleeding, whereas four cases involved bleeding that occurred following an intra-procedural endoscopic intervention. Initial hemostasis was successfully attained in all instances. PuraStatTM was used as a monotherapy in six cases, while in three cases it was used in conjunction with other hemostatic methods (1 clips, 1 cautery, 1 coil and glue injection). Five cases were identified by the proceduralist as having a high risk of re-bleeding. This was due to either thrombocytopenia (platelet count < 50,000) (1 case), use of pre or post operative therapeutic anticoagulation (2 cases), or active gastrointestinal malignancy as the etiology of the bleed (3 cases). DB was observed in 44% of cases, which occurred between 1-2 days after the procedure. All of these cases required post intervention blood transfusions, with two of them requiring repeat endoscopic intervention. There were no complications related to the usage of PuraStat.

Discussion: We observed a high rate of DB, suggesting that PuraStat may not be a reliable hemostatic method for use in active gastrointestinal bleeding, especially in patients at high risk of rebleeding. PuraStat may be better used as primary prophylaxis for bleeding in high-risk endoscopic procedures, as it is currently commonly used in practice. Limitations to this study include our small sample size and lack of a control group comparing it to conventional hemostatic methods in a similar patient population.


Disclosures:


Sohrab Zand, MBBCh¹, Christopher J. Tricarico, MD², Michael Mintz, MD³, Shamin H. Mahmud, ⁴, Madeleine Mogl, ⁵, David Wan, BS, MD³. P0590 - Purastat for Hemostasis in Gastrointestinal Bleeding: A Single Center Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.