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Vasoactive drugs controlled variceal bleeding comparably before endoscopy in cirrhotic patients

Three vasoactive drugs safely and effectively controlled bleeding among patients with cirrhosis and gastroesophageal variceal hemorrhage, according to new data.

Researchers randomly assigned 780 patients with cirrhosis and variceal bleeding to terlipressin (n=261), somatostatin (n=259) or octreotide (n=260) for 5 days before undergoing endoscopy.

Active bleeding was observed among 44.4% of the somatostatin group, 43.7% of the terlipressin group, and 43.5% of the octreotide group at initial endoscopy. Five-day treatment success was achieved by 84.5% of the study group, including 86.2% of terlipressin, 83.4% of somatostatin and 83.8% of octreotide patients.

Similar success rates were found for controlling bleeding without treatment rescue (89.7%, terlipressin; 87.6%, somatostatin; 88.1%, octreotide), rebleeding (3.4%, 4.8% and 4.4%) or mortality (8%, 8.9% and 8.8%). Adverse events occurred in 7.3% of all patients. Multivariate analysis revealed independent predictive factors for 5-day treatment failure, including high serum creatinine level, gastric variceal bleeding, active bleeding in the emergency endoscopy and Child-Turcotte-Pugh grade C.

“Treatment response in patients with gastroesophageal variceal hemorrhage does not differ significantly between terlipressin, somatostatin and octreotide when they are administered in combination with endoscopic therapy,” the researchers concluded. “Therefore, any of these drugs could be used equivalently as an adjuvant therapy to standard endoscopic treatments to control gastroesophageal variceal hemorrhage.”

Disclosure: The researchers report no relevant financial disclosures.