First-line Medications for Bleeding in Liver Cirrhosis

Bleeding caused by liver cirrhosis is often due to the rupture of esophageal and gastric varices. In such cases, vasoactive drugs like terlipressin, somatostatin, or its analogs are commonly used to reduce portal pressure, which helps control bleeding. Additionally, acid suppression therapy with proton pump inhibitors (PPIs) or H2 receptor antagonists is recommended to decrease gastric acidity and increase gastric pH, thereby promoting hemostasis.

To prevent bacterial infections that may complicate the condition, antibiotics such as third-generation cephalosporins or quinolones are typically prescribed for a duration of 5 to 7 days. Blood transfusions may be necessary in severe cases, with a target hemoglobin level of at least 70 g/L. For patients with coagulopathy, fresh frozen plasma, prothrombin complex concentrate, or fibrinogen may be administered to restore normal clotting function. Thrombocytopenic patients might benefit from platelet transfusions, while those with vitamin K deficiency can receive short-term vitamin K supplementation.

When pharmacological interventions fail to achieve hemostasis, endoscopic therapies such as band ligation, sclerotherapy, or tissue adhesive injection offer effective and safer alternatives. These procedures can be combined with drug therapy for improved outcomes. In some situations, interventional radiology or surgical approaches may also be considered. During the acute bleeding phase, fasting and fluid replacement therapy are essential components of patient management.