This handout is for acute variceal hemorrhage (esophageal / gastric / ectopic). Your care team identified this based on: hematemesis (red or coffee-ground) (baveno vii de franchis 2022).
Other reasons your team may use this plan: melena or hematochezia in cirrhotic patient (baveno vii 2022; aasld 2023); syncope or hypotension in cirrhotic patient (baveno vii 2022 acute bleed criteria); cirrhosis with known varices presenting with bleeding (baveno vii 2022; aasld 2023).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| octreotide | 50 mcg IV bolus then 50 mcg/h infusion | IV | continuous × 3–5 d | Reduces splanchnic flow; bridge to EGD (Baveno VII 2022 de Franchis PMID 35120736; AASLD 2023) |
| ceftriaxone | 1 g IV | IV | daily × 5–7 d | Reduces SBP and infection mortality (Cochrane; Baveno VII 2022; AASLD 2023; EASL 2018) |
| terlipressin | 2 mg IV q4h × 24 h then 1 mg IV q4h | IV | q4h | Where available; CONFIRM trial benefit in HRS-AKI; ischemic risk (Baveno VII 2022; EASL 2018) |
| pantoprazole | 80 mg IV bolus then 8 mg/h | IV | continuous × 72 h then PO | Acid suppression for PUD if mixed source (ACG 2021 UGIB) |
| lactulose | 30–45 mL | PO/PR | q6h titrate | HE risk after blood meal (AASLD 2023 HE guideline; EASL 2018) |
| rifaximin | 550 mg | PO | BID | Adjunct to lactulose for HE prevention (Bass NEJM 2010; AASLD 2023) |
Plan: Acute variceal hemorrhage bundle
Call 911 or go to the nearest emergency room right away if you have:
Hepatology q1-3 mo; serial EVL until obliteration; transplant evaluation; HE management (Baveno VII 2022 secondary prophylaxis; AASLD 2023)
Guideline: Baveno VII consensus (J Hepatol 2022); AASLD 2017 portal HTN; Garcia-Pagan NEJM 2010 (early TIPS); Villanueva NEJM 2013 (restrictive transfusion)