Refractory GI Bleeding: What Next?

My patient is an 87-year-old woman who requires transfusion every 3 weeks for chronic GI bleeding. Despite a full workup and multiple endoscopies, her stool remains heme-positive. Is aminocaproic acid( an option in this setting?
—Gary Freeman, MD

There are no prospective studies of the safety and efficacy of aminocaproic acid for the control of GI bleeding of obscure origin. Past studies using antifibrinolytic agents in patients with bleeding peptic ulcers did not demonstrate efficacy. A potentially thrombogenic drug such as aminocaproic acid may cause unwanted vascular arterial occlusion, especially cerebrovascular occlusion, in a patient of advanced age.
A complete workup for bleeding of this degree should include a push enteroscopy to exclude angiodysplasia of the small intestine. A new device that may be useful in establishing a diagnosis is the wireless video capsule.
—Christopher J. Gostout, MD
  Professor of Medicine
  Department of Gastroenterology and Hepatology
  Mayo Clinic
  Rochester, Minn