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Methods to achieve hemostasis in patients with acute variceal hemorrhage

Jasmohan S Bajaj, MD
Arun J Sanyal, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


Among patients with cirrhosis, varices form at a rate of 5 to 15 percent per year, and one-third of patients with varices will develop variceal hemorrhage [1]. The current treatment options for acute variceal hemorrhage include medications (vasopressin, somatostatin, and their analogs), endoscopy, transjugular intrahepatic portosystemic shunt placement, and surgery.

This topic will review the pharmacologic, endoscopic, radiologic, and surgical methods used to achieve hemostasis in patients with acute variceal hemorrhage. The general management of patients with variceal hemorrhage, primary and secondary prophylaxis against variceal hemorrhage, and a detailed discussion of endoscopic variceal ligation are discussed separately. (See "General principles of the management of variceal hemorrhage" and "Primary and pre-primary prophylaxis against variceal hemorrhage in patients with cirrhosis" and "Prevention of recurrent variceal hemorrhage in patients with cirrhosis" and "Endoscopic variceal ligation".)

The management of variceal hemorrhage is also discussed in a 2007 guideline from the American Association for the Study of Liver Diseases [2], a 2014 guideline from the American Society of Gastrointestinal Endoscopy [3], a 2015 international consensus statement (Baveno VI) [4], and a 2015 guideline from the British Society of Gastroenterology [5]. The discussion that follows is consistent with those guidelines [2].


The existing literature is confounded by the variable use of terminology across studies. As a result, several definitions were agreed upon during a consensus conference, which simplify evaluation of published studies and render new studies more comparable [6]:

Time zero – The time of admission to a medical care facility.

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Literature review current through: Dec 2017. | This topic last updated: May 05, 2017.
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