Treatment Options for Hemostasis in Patients with Cirrhosis and Variceal Bleeding

For patients suffering from cirrhosis and esophageal or gastric variceal bleeding, the use of vasoactive agents such as terlipressin, somatostatin, or its analogs is highly recommended. These medications help reduce portal pressure, which is crucial in controlling acute bleeding episodes. Additionally, acid suppression therapy using proton pump inhibitors (PPIs) or H2 receptor blockers can increase gastric pH levels, thereby promoting clot stability and reducing the risk of rebleeding.

Antibiotic prophylaxis is also an essential component of management, with third-generation cephalosporins or fluoroquinolones commonly prescribed for a duration of 5 to 7 days to prevent infections that may complicate the clinical course. In cases of significant anemia, red blood cell transfusions are indicated to maintain hemoglobin levels at or above 70 g/L.

Patients with coagulopathy may benefit from the administration of fresh frozen plasma, prothrombin complex concentrate, or fibrinogen to restore normal clotting function. If thrombocytopenia is severe, platelet transfusion should be considered. For those with suspected vitamin K deficiency, short-term supplementation with vitamin K1 may improve coagulation parameters.

When pharmacologic interventions fail to achieve hemostasis, mechanical approaches such as balloon tamponade with a Sengstaken-Blakemore tube can provide temporary control. Endoscopic therapies including band ligation, sclerotherapy, or tissue adhesive injection are preferred options in emergency settings. Combining drug therapy with endoscopic intervention has shown superior efficacy and safety profiles compared to monotherapy.

In more refractory cases, interventional radiology procedures or surgical management may be necessary. It is also important to emphasize that during the acute phase of bleeding, patients should remain nil per os (NPO) and receive appropriate intravenous fluids to maintain hydration and hemodynamic stability.