In a patient with cirrhosis and upper gastrointestinal bleeding, start a vasoactive drug such as terlipressin or octreotide and prophylactic antibiotics as soon as variceal bleeding is suspected, before endoscopy. Transfuse conservatively, to a haemoglobin of about 7 g/dL, because over-transfusion raises portal pressure. Endoscopy should follow within 12 hours once the patient is stabilised.
- Start a vasoactive drug at first suspicion of variceal bleeding.
- Give prophylactic antibiotics, such as ceftriaxone, to every patient with cirrhosis and GI bleeding.
- Use a restrictive transfusion threshold of about 7 g/dL haemoglobin.
- Arrange endoscopy within 12 hours after resuscitation.
Why it matters
These steps cut mortality and can be started anywhere, before the endoscopist arrives.
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