title: Meta-analysis: vasoactive medications for the management of acute variceal bleeds.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To undertake a meta-analysis of the efficacy of vasoactive medications in patients having acute variceal bleeds.
  
  
  METHODS
  Randomised controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds were identified based on systematic searches of nine electronic databases and multiple sources of grey literature.
  
  
  RESULTS
  The search identified 3011 citations, and 30 trials with a total of 3111 patients met eligibility criteria. The use of vasoactive agents was associated with a significantly lower risk of 7-day mortality (RR 0.74; 95% CI 0.57-0.95; P = 0.02; I(2) = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13-1.30; P < 0.001; I(2) = 28%; very low quality of evidence), lower transfusion requirements (pooled mean difference -0.70 units of blood transfused, 95% CI -1.01 to -0.38; P < 0.001; I(2) = 82%; moderate quality of evidence), and a shorter duration of hospitalisation (pooled mean difference -0.71 days; 95% CI -1.23 to -0.19; P = 0.007; I(2) = 0%; low quality of evidence). Studies comparing different vasoactive agents did not show a difference in efficacy, although the quality of evidence was very low.
  
  
  CONCLUSIONS
  The use of vasoactive agents was associated with a significantly lower risk of acute all-cause mortality and transfusion requirements, and improved control of bleeding and shorter hospital stay. Studies comparing different vasoactive medications failed to demonstrate a difference in efficacy.
authors.affiliation: Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Wells
authors.forename: N
authors.initials: N
authors.lastname: Chande
authors.forename: P
authors.initials: P
authors.lastname: Adams
authors.forename: M
authors.initials: M
authors.lastname: Beaton
authors.forename: M
authors.initials: M
authors.lastname: Levstik
authors.forename: E
authors.initials: E
authors.lastname: Boyce
authors.forename: M
authors.initials: M
authors.lastname: Mrkobrada
mesh_terms: D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D000077585:Terlipressin; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D006490:Hemostatics; D014667:Vasopressins; C051458:vapreotide; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D015282:Octreotide