Effect of acid and pepsin on blood coagulation and platelet aggregation: A possible contributor to prolonged gastroduodenal mucosal hemorrhage

doi:10.1016/0016-5085(78)90352-9

Gastroenterology

Volume 74, Issue 1, January 1978, Pages 38-43

https://doi.org/10.1016/0016-5085(78)90352-9 Get rights and content

Abstract

In a series of in vitro studies, both the soluble (plasmatic) coagulation system and the cellular (platelet-mediated) aspect of blood coagulation were shown to be extremely sensitive to relatively minor increases in hydrogen ion concentration. All studies became abnormal at pH 6.8. At pH 6.4, assays of the intrinsic and extrinsic coagulation systems, the polymerization of fibrinogen, and assay of the availability of platelet phospholipid (platelet factor 3) were twice prolonged over control values. Platelet aggregation was reduced by more than 50%. At pH 5.4 in vitro, platelet aggregation and plasma coagulation were both virtually abolished. Furthermore, previously formed platelet aggregates disaggregated at a slightly acid pH. Pepsin further enhanced platelet disaggregation. Because gastric acidity is normally two to four orders of magnitude greater than that which abolishes platelet aggregation and plasma clotting in vitro, and pepsin is present in abundance, we call attention to the probable antihemostatic effect of hydrocloric acid and pepsin in the upper gastrointestinal tract. This in vitro study may provide a rationale for meticulous regulation of intragastric pH in an effort to control upper gastrointestinal hemorrhage.

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Citation Excerpt :
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^☆: This study was supported in part by Training Grant AM-5424 and by Research Grant AM-10571 from the National Institutes of Health.

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Effect of acid and pepsin on blood coagulation and platelet aggregation: A possible contributor to prolonged gastroduodenal mucosal hemorrhage☆

Abstract

Am J Surg

Am J Surg

Am J Surg

Lancet

The rate of blood loss from skin punctures during the Ivy bleeding time test

J Clin Pathol

Local environmental factors affecting hemostasis in bleeding from the upper gastrointestinal tract

Prog Hematol

Physiology of the Digestive Tract

The effect of gastric cooling on hemostasis

Surg Gynecol Obstet

Control of acute gastric mucosal hemorrhage; intra-arterial infusion of posterior pituitary extract

N Engl J Med

Intraarterial vasopressin in the treatment of upper gastrointestinal hemorrhage: a prospective, controlled clinical trial

Gastroenterology

Levarterenol irrigation:control of massive gastrointestinal bleeding in poor risk patients

JAMA

Treatment of hemorrhagic gastritis by antacid

Ann Surg

Aggregation of blood platelets by ADP

Nature