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Vasoactive agents lower mortality in patients with acute variceal bleeds

Clinical Question:
For patients with acute variceal bleeds, does the use of vasoactive agents improve outcomes?

Bottom Line:
The use of vasoactive agents such as vasopressin, somatostatin, and octreotide decreases the risk of all-cause mortality in patients with acute variceal bleeding. (LOE = 1a-)

Reference:
Wells M, Chande N, Adams P, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012;35(11):1267-1278.  [PMID:22486630]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Self-funded or unfunded

Allocation:
Uncertain

Setting:
Inpatient (any location)

Synopsis:
Vasoactive agents such as vasopressin and somatostatin and their analogues (terlipressin, vapreotide and octreotide) are used to treat acute variceal bleeding. These investigators searched EMBASE, MEDLINE, and the EBM Reviews databases to identify randomized controlled trials that compared the intravenous use of these vasoactive agents with each other or with placebo in adults presenting with variceal bleeding. Two investigators independently selected the studies, abstracted data, and assessed study quality. The final selection included 30 studies that compared vasoactive medications with placebo (n = 3111) and 27 studies that compared different vasoactive agents with each other (n = 2293). Moderate-quality evidence showed that vasoactive agents decreased 7-day mortality risk compared with placebo or routine medical management (relative risk = 0.74; 95% CI, 0.57-0.95; P = .02). There was also evidence of decreased risk of rebleeding, decreased transfusion requirements, and shorter hospital stays with the use of vasoactive agents although the quality of this evidence was low to moderate. For the studies comparing different agents with each other, there was no difference in mortality detected.

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