AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis

25 Jan 2024 • The American Gastroenterological Association's new clinical practice update provides recommendations about these medications.

Key Recommendations

  • Vasoactive drugs should be initiated as soon as a diagnosis of variceal hemorrhage is suspected, preferably before endoscopy, and should be continued for 2 to 5 days to prevent rebleeding.
  • Octreotide remains the vasoactive drug of choice, given its safety profile.
  • IV albumin should be given at the time of large-volume (>5 L) paracentesis.
  • IV albumin can be considered in patients with SBP but should not be given to patients (hospitalized or not) with uncomplicated ascites.
  • IV albumin is the volume expander of choice in hospitalized patients with cirrhosis and ascites who present with AKI.
  • Terlipressin, which can be given through a peripheral line and does not require intensive care monitoring, is the preferred vasoactive drug for HRS; use of concurrent albumin can be considered when accounting for patient's volume status.
  • Terlipressin use is contraindicated in patients with hypoxemia and in patients with ongoing coronary, peripheral, or mesenteric ischemia.

Source: NEJM J-Watch | Read full story

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