Variceal Bleeds

Terlipressin

Vasopressins such as Terlipressin cause arterial vasoconstriction, reducing portal venous pressure but at the risk of end-organ ischaemia. Terlipressin has been shown to reduce blood loss from actively bleeding varices and confers a 34% relative risk reduction in risk of mortality. It can be given as a bolus.

Octreotide

This is a somatostatin analogue that causes relaxation of vascular smooth muscle and reduces portal venous pressure. It is unlicensed for use in GI bleeding and is suggested if terlipressin is unavailable. [14]

Antibiotics

Intravenous should be given to all patients with suspected variceal bleeding. A Cochrane review found a significant reduction in bacterial infections, mortality, rebleeding events, and length of stay. Local guidelines should be used for antibiotic selection. [15]