Meta-analysis: vasoactive medications for the management of acute variceal bleedsM. Wells, N. Chande, P. Adams, M. Beaton, M. Levstik, E. Boyce, M. MrkobradaAlimentary Pharmacology & TherapeuticsVolume 35, Issue 11, pages 1267–1278, June 2012 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.
Aim.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; I2 = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13–1.30; P < 0.001; I2 = 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; I2 = 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; I2 = 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. leggi l’articolo