Management of Acute Variceal Bleeding

• Patients with an acute UGIB secondary to esophageal or gastric varices frequently present in extremis.
• The initial resuscitation of patients with a variceal bleed should focus on the administration of antibiotics, packed red blood cells (PRBC), vasoactive agents, and emergent endoscopy.
• Antibiotics have been shown to reduce recurrent bleeding and mortality. A third-generation cephalosporin (e.g., ceftriaxone) is commonly recommended as the initial antibiotic of choice.
• Utilize a restrictive PRBC transfusion strategy to target a Hb between 7 to 8 g/dL.
• Vasoactive agents (e.g., octreotide) reduce portal pressure through splanchnic vasoconstriction and have been shown to reduce acute bleeding and the need for transfusion.

References

Boregowda U, et al. Update on the management of gastrointestinal varices. World J Gastrointest Pharmacol Ther. 2019; 10:1-21.