Comparison of drugs facilitating endoscopy for patients with  acute variceal bleeding: a systematic review and network meta-analysis

Zou, Zi-Yuan; Yan, Xiaojin; Lu, Huanpeng; Qi, Xingshun; Gu, Ye; Li, Xun; Wu, Bin; Qi, Xiaolong

doi:10.21037/atm.2019.12.26

Cited by 8 publications

(9 citation statements)

References 54 publications

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“…Corley et al [36] reported a 47% lower risk of complications with Octreotide than Terlipressin or Vasopressin, and a 69% lower risk of presenting major complications. Zou et al [40] also found Somatostatin and Octreotide had fewer adverse events and non-serious adverse events than V and T. Our findings were consistent with most primary studies that reported adverse events. Furthermore, these findings remained the same despite the different doses of vasoactive agents.…”

Section: Comparison With Other Studiessupporting

confidence: 89%

“…Previous SRs [6,11,[35][36][37] have compared the efficacy of vasoactive agents with placebo, other vasoactive agents, or other non-pharmacological therapy. Few SRs have attempted to directly compare vasoactive agents used in AVB [10,38], and others have compared different therapies for AVB by network meta-analysis [39][40][41]. However, many of these SRs are outdated, did not include RCTs from Asia, only evaluated the efficacy and non-safety outcomes, did not adequately assess risk of bias or methodological quality, and finally, did not pool all the studies and only presented by subgroups assuming that certain characteristics influence outcomes [11,37].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Huaringa-Marcelo

Huaman

Brañez-Condorena

et al. 2021

JGLD

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Background and Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I 2 =57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.

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Section: Comparison With Other Studiessupporting

confidence: 89%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Huaringa-Marcelo

Huaman

Brañez-Condorena

et al. 2021

JGLD

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“…In order to study the microcirculation of the bladder, he used the original technique of intravesical high-frequency Doppler ultrasound. e intensity of pain syndrome and voiding disturbance were assessed using the PUF questionnaire, and psychoemotional status was assessed using the A.T. Depression Scale [10]. However, their research only focused on the specific efficacy of vasoactive drugs for a certain disease and did not analyze the general mechanism of action for cardiovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Vasoactive Drug Therapy and Clinical Nursing of Patients with Cardiovascular Disease

Li¹,

Xu²,

Feng³

et al. 2022

Contrast Media & Molecular Imaging

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Cardiovascular disease (CVD) is a common human disease with a large number of patients. Vasoactive drugs have a good effect on the contraction and expansion of blood vessels, which can provide certain help for the management of cardiovascular diseases. However, the clinical care of cardiovascular disease has always been based on the superficial resistance level of body fat, weight, and so on, which is unfavorable for the real recovery of patients with cardiovascular disease. This article aims to quantitatively evaluate the effects of clinical care based on vasoactive drug therapy and intrinsic factors of cardiovascular disease. For the treatment of vasoactive drugs, this paper selects the principle of action of the adrenal hormone to judge and analyze the expansion and contraction of the cardiovascular disease. For the clinical nursing of patients with cardiovascular disease, based on multivariate logistic regression, this paper selects internal factors such as age and blood pressure to model the nursing effect. Experiments have shown that the logistic regression model established in this paper can evaluate well the recovery effect of patients with cardiovascular disease. The AUC value of the model reached around 0.9. This showed that the clinical care of patients with cardiovascular disease can not only rationally judge the recovery effect through the model but also adjust the physical and mental conditions of patients with cardiovascular disease according to the coefficients of the model to achieve the best recovery effect.

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“…For portal pressure reduction, various drugs such as vasopressin, nitroglycerin, terlipressin, somatostatin, octreotide, nadolol, or propranolol are useful 29,81 . Carvedilol, a potent nonselective beta‐blocker with mild anti‐alpha 1 adrenergic activity, have shown promising results in the management of portal hypertension.…”

Section: Treatmentmentioning

confidence: 99%

“…For portal pressure reduction, various drugs such as vasopressin, nitroglycerin, terlipressin, somatostatin, octreotide, nadolol, or propranolol are useful. 29,81 Carvedilol, a potent nonselective turn causes vasodilation. 82 Carvedilol was associated with a significantly greater decrease in hepatic venous pressure gradient than those induced by propranolol or nadolol (a mean difference of 7-9% of reduction in the hepatic venous pressure gradient), and there were no major differences in the side-effects apart from a slightly greater decrease in the arterial blood pressure caused by carvedilol.…”

Section: ) Pharmacotherapymentioning

confidence: 99%

Management of portal hypertension based on portal hemodynamics

Yoshida

Shimizu

Yoshioka

et al. 2021

Hepatology Research

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Portal hypertension is most commonly caused by chronic liver disease. As liver damage progresses, portal pressure gradually elevates and hemodynamics of the portal system gradually change. In normal liver, venous returns from visceral organs join the portal trunk and flow into the liver (hepatopetal blood flow). As portal pressure increases due to liver damage, congestion of some veins of the visceral organ occurs (blood flow to and from). Finally, the direction of some veins (the left gastric vein in particular) of the visceral organ change (hepatofugal blood flow) and develop as collateral veins (portosystemic shunt) to reduce portal pressure. Therefore, esophagogastric varices serve as drainage veins for the portal venous system to reduce the portal pressure. In chronic liver disease, as intrahepatic vascular resistance is increased (backward flow theory) and collateral veins develop, adequate portal hypertension is required to maintain portal flow into the liver through an increase of blood flow into the portal venous system (forward flow theory). Splanchnic and systemic arterial vasodilatations increase the blood flow into the portal venous system (hyperdynamic state) and lead to portal hypertension and collateral formation. Hyperdynamic state, especially around the spleen, is detected in patients with portal hypertension. The spleen is a regulatory organ that maintains portal flow into the liver. In this review, surgical treatment, interventional radiology, endoscopic treatment, and pharmacotherapy for portal hypertension (esophagogastric varices in particular) are described based on the portal hemodynamics using schema.

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Comparison of drugs facilitating endoscopy for patients with acute variceal bleeding: a systematic review and network meta-analysis

Cited by 8 publications

References 54 publications

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

[Retracted] Vasoactive Drug Therapy and Clinical Nursing of Patients with Cardiovascular Disease

Management of portal hypertension based on portal hemodynamics

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