High-dose vasopressin for acute variceal hemorrhage. Clinical advantages without adverse effects

K. R. Sirinek and B. A. Levine
Department of Surgery, University of Texas Health Science Center, San Antonio.

Based on laboratory and clinical data from our institution, 113 patients with cirrhosis, portal hypertension, and acute hemorrhage from esophageal varices were treated with high-dose vasopressin arginine (1 to 1.5 U/min) to control the acute bleeding and reduce blood loss during portosystemic shunt operations. Compared with patients receiving a lower dose of vasopressin infusion, these patients had a reduction in both postoperative mortality (21% vs 6%) and the proportion of patients requiring emergency operation (40% vs 18%). A decrease in operative blood loss (1340 vs 793 mL) was also seen. Adverse effects of vasopressin were increased by high-dose infusion, but no significant morbidity occurred. These results suggest that high-dose vasopressin infusion can reduce the mortality of acute variceal hemorrhage and porto-systemic shunting primarily by allowing patients to improve hepatic function prior to an elective operation and by decreasing intraoperative blood loss.