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