Pharmacologic intervention during the acute bleeding episode.
The risk of recurrent variceal bleeding after an acute episode of bleeding has been controlled in significant with rebleeding rates as high as 80% between one and two years. Pharmacologic therapy has a definite role in the prevention of recurrent variceal bleeding and should be started as soon as the acute bleeding event has been controlled. Serial hemodynamic measurements are critical for success. Non-selective beta-blocker therapy is a reasonable first line approach followed by the addition of a long-acting nitrate for patients not achieving a 20% reduction in the hepatic venous pressure gradient. Most patients will require combination pharmacotherapy or combined endoscopic therapy with pharmacotherapy.
Nader
A
A
Tufts University School of Medicine, Faulkner Hospital, Boston, Massachusetts, USA.
Grace
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ND
D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000187:drug effects; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D017082:Portal Pressure / Q000187:drug effects; D012307:Risk Factors; D013004:Somatostatin / Q000627:therapeutic use; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use
D000959:Antihypertensive Agents; D006728:Hormones; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014667:Vasopressins; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D005996:Nitroglycerin