Natural history of bleeding peptic ulcers with a tightly adherent blood clot: a prospective observation

Gastrointest Endosc. 1996 May;43(5):470-3. doi: 10.1016/s0016-5107(96)70288-2.


Background: The natural history of a bleeding peptic ulcer with a tightly adherent blood clot remains uncertain. Controversy exists concerning removal of such blood clots at the bleeding ulcer base. This article presents the natural history of a bleeding peptic ulcer with a tightly adherent clot and defines the characteristics of those requiring aggressive management.

Methods: Clinical parameters were analyzed to determine the independent predictors of rebleeding in these patients. One hundred one patients with bleeding peptic ulcers and tightly adherent blood clots were enrolled during a period of 12 months.

Results: Twenty-five patients (25%) rebled within 1 month. With a multivariate analysis, we found comorbid illness (odds ratio, 3.41), shock (odds ratio, 3.65), and initial hemoglobin at or below 10 gm/dL (odds ratio, 2.99) to be independent predictors of rebleeding.

Conclusions: Most patients with a tightly adherent clot in an ulcer have an uneventful course. However, endoscopic therapy may prove to be beneficial in the subset of patients with independent predictors of rebleeding.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Coagulation / physiology*
  • Endoscopy, Digestive System
  • Female
  • Follow-Up Studies
  • Hemoglobins / metabolism
  • Hemostasis, Endoscopic / methods
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peptic Ulcer Hemorrhage / blood
  • Peptic Ulcer Hemorrhage / etiology*
  • Peptic Ulcer Hemorrhage / therapy
  • Prospective Studies
  • Recurrence


  • Hemoglobins