علاج الفشل الكبدي المزمن في تليف الكبد مع ارتفاع ضغط الدم البابي والنزيف الدوالي الحاد

References

DOI: 10.1016/j.jhep.2018.03.024

• Acute variceal haemorrhage (AVH) must be suspected in any cirrhotic patient presenting with upper acute GI bleeding and treatment should be started as soon as bleeding is clinically confirmed, regardless the lack of confirmation by upper endoscopy.
• Volume replacement should be initiated promptly to restore and maintain haemodynamic stability (III;1).
• A restrictive transfusion strategy is recommended in most patients with a haemoglobin threshold for transfusion of 7 g/dl and a target range of 7–9 g/dl (I;1).
• Vasoactive drug therapy should be initiated as soon as acute variceal bleeding is suspected, and before endoscopy. Terlipressin, somatostatin or octreotide are accepted options. In patients with acute variceal bleeding drug therapy should be administered for three to five days (I;1).
• The combination of vasoactive drugs and ligation is recommended as the first therapeutic option in acute variceal bleeding (I;1).