Meta‐analysis: vasoactive medications for the management of acute variceal bleeds

@article{Wells2012MetaanalysisVM,
  title={Meta‐analysis: vasoactive medications for the management of acute variceal bleeds},
  author={Malcolm M. Wells and Nilesh Chande and Paul C. Adams and Melanie D. Beaton and Mark A. Levstik and Erin Boyce and Marko Mrkobrada},
  journal={Alimentary Pharmacology \& Therapeutics},
  year={2012},
  volume={35}
}
Vasoactive medications such as vasopressin, somatostatin and their analogues (terlipressin, vapreotide and octreotide) are commonly used for the treatment of acute variceal bleeding. However, the risks and benefits of these interventions are not well understood. 
Pharmacologic Management of Portal Hypertension.
Terlipressin, somatostatin, or octreotide are recommended as pharmacologic treatment of acute variceal hemorrhage. Nonselective β-blockers decrease the risk of variceal hemorrhage and hepaticExpand
Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis.
TLDR
In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S, however, the use of T-v showed an increased risk of adverse events compared toO-S. Expand
The Role of Medical Therapy for Variceal Bleeding.
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This review summarizes current management of AVH and prevention of recurrent hemorrhage with a focus on pharmacologic therapy. Expand
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TLDR
A comprehensive review of evaluation and management of variceal bleeding in cirrhosis patients is provided. Expand
Experience of Vasoactive Therapy from Esophageal Variceal Bleeding in Patients with Hepatic Cyrrosis and Syndrome of Portal Hypertension
TLDR
The presented clinical experience of the use of synthetic somatostatin analogues in complex therapy at acute esophageal variceal bleeding allows recommending their wide use in the practice of urgent surgical clinics. Expand
Management of acute variceal bleeding.
TLDR
Patients who have a high likelihood of failing initial attempts at hemostasis may benefit from a more aggressive approach using TIPS earlier in their management. Expand
Octreotide: a drug often used in the critical care setting but not well understood.
TLDR
The biology and pharmacology of SST, octreotide, and other SST analogs are discussed and the evidence behind their use in esophageal variceal bleeds, hepatorenal syndrome, hypoglycemia due to sulfonylurea poisoning, and chylous pleural effusions is reviewed. Expand
Epidemiology, diagnosis and early patient management of esophagogastric hemorrhage.
TLDR
The epidemiology, diagnosis, and nonendoscopic management of acute variceal bleeding is discussed. Expand
An update on the management of acute esophageal variceal bleeding.
TLDR
The most recent advances in the management of variceal bleeding are reviewed and the recent recommendations of the Baveno VI consensus conference are discussed. Expand
Vasoactive Agents for the Management of Variceal Bleeding: A Mixed Treatment Comparison Network Meta-analysis and Trial Sequential Analysis of Randomized Clinical Trials.
TLDR
Terrlipressin could be the best agent in the vasoconstrictor category for managing variceal bleeding and somatostatin and vasopressin can serve as alternatives. Expand
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References

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TLDR
The present trial compared the effectiveness and complications of intravenous somatostatin and vasopressin in treatment of variceal bleeding to find out if these drugs should be given as continuous intravenous infusions. Expand
Clinical trial: the effect of somatostatin vs. octreotide in preventing post‐endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices
TLDR
HVPG increases significantly after endoscopic therapy in patients with bleeding oesophageal varices, which may precipitate further haemorrhage, and whether vasoactive drugs can suppress these changes remains unknown. Expand
Pharmacological Treatment of Acute Variceal Bleeding
A review of the progress in pharmacological treatment of portal hypertension is best considered in the clinical setting of the acute variceal bleeding episode, the primary prophylaxis of varicealExpand
Terlipressin in bleeding esophageal varices: A placebo‐controlled, double‐blind study
The effect of terlipressin (N‐α‐triglycyl‐8‐lysinevasopressin) in bleeding esophageal varices was evaluated in a prospective placebo‐controlled study. Fifty bleeding episodes from esophagealvaricesExpand
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In a double-blind trial 60% of acute variceal bleeding episodes were controlled with terlipressin (glypressin) compared with 37% in patients given placebo (NS). Rebleeding was more common in theExpand
Terlipressin for acute esophageal variceal hemorrhage.
TLDR
The meta-analysis indicates that terlipressin was associated with a statistically significant reduction in all cause mortality compared to placebo, and might be the vasoactive agent of choice in acute variceal bleeding. Expand
CONTROLLED TRIAL OF TERLIPRESSIN ('GLYPRESSIN') VERSUS VASOPRESSIN IN THE EARLY TREATMENT OF OESOPHAGEAL VARICES
TLDR
Because of its efficacy, lack of side-effects, and ease of administration, glypressin appears to be valuable in the management of bleeding varices. Expand
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TLDR
Twenty two patients were entered into a randomised controlled clinical trial comparing the efficacy of somatostatin and vasopressin in controlling acute variceal haemorrhage and no complications were observed during treatment with som atostatin. Expand
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TLDR
It is concluded that in patients bleeding from esophageal varices or gastritis, selective intra-arterial vasopressin is more effective in controlling hemorrhage than standard therapy. Expand
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TLDR
No convincing evidence is found to support the use of emergency sclerotherapy for variceal bleeding in cirrhosis as the first, single treatment when compared with vasoactive drugs. Expand
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