급성 식도정맥류 출혈, 지혈 약물 치료, Pharmacologic Tx. to achieve hemostasis in pts with acute variceal hemorrhage
Vasoactive medications은 portal blood flow을 줄이고 급성 식도정맥류 출혈 치료에 사용됩니다. 이것들에는 vasopressin, somatostatin, terlipressin, octreotide가 있습니다. 식도정맥류가 있거나 식도정맥류 위험이 있는 환자에서 출혈이 있는 경우 내원 시에 바로 약물을 투약해야 하며 진단의 확진을 기다려서는 안됩니다. Terlipressin은 미국 이외 지역에서 선호되는 약제이고 octreotide는 미국에서 이용 가능한 약제입니다. Vasopressin은 다음과 같은 이유 때문에 거의 사용되지 않습니다.
The benefit of bleeding cessation may be counterbalanced by enhanced mortality due to extrasplanchnic vasoconstrictive properties and resultant myocardial, cerebral, bowel, and limb ischemia. Because of these considerations and the seemingly greater benefit with terlipressin, somatostatin, or a somatostatin analog, vasopressin is rarely used for the management of variceal hemorrhage in the United States.
Vasoactive medications decrease portal blood flow and are used for the treatment of acute variceal hemorrhage. They include vasopressin, somatostatin, and their analogs (terlipressin and octreotide, respectively). As a group, vasoactive medications have been shown to decrease mortality and improve hemostasis in patients with acute variceal bleeding. However, terlipressin is the only agent individually shown to reduce mortality. Pharmacologic therapy should be started at the time of presentation in a patient who has known varices or is at risk for varices. It should not be held pending confirmation of the diagnosis. Terlipressin is the preferred agent in many countries outside of the United States, whereas octreotide is the agent available in the United States. Pharmacologic therapy should be continued for three to five days.
In a meta-analysis of 30 randomized trials with 3111 patients with acute variceal bleeding, compared with placebo, the use of vasoactive medications was associated with improved hemostasis (relative risk [RR] 1.2, 95% CI 1.1-1.3) and decreases in seven-day mortality (RR 0.74, 95% CI 0.57-0.95), transfusion requirement (pooled mean difference -0.70 units, 95% CI -1.0 to -0.38), and duration of hospitalization (pooled mean difference -0.71 days, 95% CI -1.2 to -0.19).
REF. UpToDate 2020.01.19