The Effect of Carbazochrome Sodium Sulfonate in Patients with Colonic Diverticular Bleeding: Propensity Score Matching Analyses Using a Nationwide Inpatient Database

Abstract

Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.

Carbazochrome sodium sulfonate is not effective for prevention of post-gastric endoscopic submucosal dissection bleeding: A retrospective study

“…Therefore, the limited amount of blood loss during ESD might weaken the hemostatic effect of CSS. In addition, CSS is thought to approach the capillary vessels and provide a hemostatic effect [8].…”

“…Therefore, the limited amount of blood loss during ESD might weaken the hemostatic effect of CSS. In addition, CSS is thought to approach the capillary vessels and provide a hemostatic effect [ 8 ]. Because exposed blood vessels on the artificial ulcer are usually ablated during ESD, CSS might not exert the hemostatic effect in such situations.…”

“…CSS has been used to treat bleeding of the gastrointestinal and respiratory tracts. The hemostatic effect of CSS has been shown in instances of hereditary hemorrhagic telangiectasia and total knee arthroplasty; however, CSS has not demonstrated hemostatic effects in instances of colonic diverticular bleeding [7][8][9]. Therefore, research regarding the hemostatic effects of CSS is currently controversial, especially in cases of gastrointestinal bleeding.…”

“…Carbazochrome sodium sulfonate (CSS) is a hemostatic agent that reduces capillary permeability and increases capillary resistance, resulting in shortened bleeding time [ 7 , 8 ]. CSS has been used to treat bleeding of the gastrointestinal and respiratory tracts.…”

Carbazochrome sodium sulfonate and tranexamic acid combination therapy to reduce blood transfusions after 24 h of injury: A retrospective study

“…Thus, we evaluated the potential of carbazochrome sodium sulfonate (CSS), traditionally used as a hemostatic agent since the 1950s, to address this issue. 4 , 5 , 6 , 7 , 8 , 9 , 10 CSS reportedly increases capillary resistance and reverses endothelial barrier dysfunction. 11 , 12 , 13 However, no previous reports have presented clear evidence indicating CSS effectiveness alone to address all causes of hemorrhage.…”