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Vitamin K for upper gastrointestinal bleeding in people with acute or chronic liver diseases

We reviewed vitamin K for upper gastrointestinal bleeding in people with acute liver disease (that is, loss of normal liver functions which occurs in days or weeks; most often, people do not have a pre‐existing liver disease) or chronic liver disease (that is, progressive destruction of normal liver functions, usually associated with fibrotic regeneration of the liver tissue).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease

We reviewed antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Existing trials, of poor quality, indicate that antibiotic prophylaxis reduces spontaneous bacterial peritonitis among cirrhotic patients with ascites and no gastrointestinal bleeding

Spontaneous bacterial peritonitis (infection and inflammation of the membrane lining the abdominal cavity) is a frequent complication among cirrhotic patients (patients with end‐stage liver disease marked by irreversible scarring of liver tissue) and is associated with significant morbidity and mortality. Selective intestinal decontamination, employing antibiotics, is a proposed prophylactic (preventive) measure. This systematic review of randomised clinical trials assesses whether antibiotic prophylaxis prevents spontaneous bacterial peritonitis and mortality among cirrhotic patients with ascites (excess fluid in the abdominal cavity) and no gastrointestinal bleeding. Nine trials are included in the review. The pooled rates of spontaneous bacterial peritonitis and mortality indicate that antibiotic prophylaxis reduces both. There are very few reports of adverse events. Reviewing these trials, we found poor methodology, evidence suggesting publication bias, and limited follow‐up periods. Thus, the recommendation to prescribe prophylactic antibiotics to cirrhotic patients without gastrointestinal bleeding is hampered by quality of the trials that generated the data. Due to potential hazards, both to society as a whole and the patients, as individuals, before antibiotic prophylaxis can be confidently recommended, trials of better design, well reported, and of longer follow‐up are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Recombinant human activated factor VII for upper gastrointestinal bleeding in patients with liver diseases

People with liver disease have an increased risk of upper gastrointestinal bleeding. Upper gastrointestinal bleeding is a frequent cause of morbidity and mortality in this population group. Due to severe liver damage, these people acquire coagulopathy (a bleeding disorder). Therefore, one of the approaches used for treating upper gastrointestinal bleeding is recombinant human activated factor VII, which is identical in structure and activity to human factor VII. The review includes two randomised clinical trials with 493 participants. The risk of bias was low. Both trials compared recombinant human activated factor VII with placebo. The meta‐analysis showed that the recombinant human activated factor VII does not seem to reduce mortality in patients with liver disease and suffering from upper gastrointestinal bleeding, irrespective of the grade of liver damage. The current evidence is insufficient to support or reject recombinant human activated factor VII for these patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

Bleeding from lesions in the oesophagus, stomach or duodenum is a common medical emergency. Research has suggested that reducing the amount of acid in the stomach may help to control the bleeding, but it is unknown if early initiation of such treatment (that is, before endoscopic diagnosis) is beneficial for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Red blood cell transfusion for the management of severe upper gastrointestinal bleeding

Bleeding in the upper gastrointestinal tract is common, affecting up to 1 in 1000 adults per year. It leads to death in 10% to 30% of cases, depending on whether patients are admitted with bleeding or bleed whilst in hospital with something else. Patients present with vomiting of fresh or partially digested blood, or with the passage of digested blood from the bowel (melaena). They may also present with symptoms associated with low blood pressure (which can occur secondary to rapid haemorrhage), or with symptoms of anaemia. Red blood cells may be transfused to patients to improve the blood pressure, haemoglobin concentration, or both, before the cause of the bleeding is identified and treated, usually with upper gastrointestinal endoscopy. Patients may also receive a transfusion after endoscopy to correct the haemoglobin concentration once the haemorrhage has been controlled. It is possible that blood transfusion (which has some serious potential adverse effects) may not always improve the patients' condition and may even make the bleeding worse.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antibiotic prophylaxis for prevention of bacterial infections and death in cirrhotic patients with upper gastrointestinal bleeding

Patients with liver cirrhosis have an impaired immune response. Often, liver cirrhosis patients experience complications from portal hypertension, such as gastroesophageal varices. These varices can bleed, increasing the risk of infection and death in a short period of time, despite proper endoscopic management. Patients who develop bacterial infections during hospitalisation for gastroesophageal haemorrhage are at increased risk of dying. Twelve trials (1241 patients) assessing several antibiotic prophylaxis regimens versus no intervention or placebo were analysed, showing that antibiotic prophylaxis successfully reduced the incidence of bacterial infections. Antibiotic prophylaxis was also associated with a reduction in mortality, mortality from bacterial infections, rebleeding rate, and days of hospitalisation. The prophylactic treatment was not associated with important adverse effects. Five trials (650 patients) assessed one antibiotic regimen compared with another. All antibiotic regimens provided similar benefits and none seemed superior. Thus, to this point there is no evidence to recommend one specific antibiotic regimen over the other. All trials analysed were subject to bias; thus, results should be interpreted carefully.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Tranexamic acid, an agent that promotes blood clotting, for serious or uncontrolled upper gastrointestinal bleeding

Upper gastrointestinal bleeding is a common reason for emergency hospital admission. The prognosis is serious. Some patients may die as the result of uncontrolled bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Fasting for haemostasis in children with gastrointestinal bleeding

To determine the effects and safety of fasting for haemostasis in children with gastrointestinal bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Evidence to establish the beneficial and harmful effects of antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients is lacking

Randomised trials with antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients could not be found. Valid evidence for or against the use of antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients is lacking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

High‐dose corticosteroids in heart surgery

During heart surgery, high doses of corticosteroids aiming to reduce inflammation are often administered. This practice, however, is controversial since there is no evidence available to show clear benefits. Moreover, corticosteroids have the potential of important side‐effects. The aim of this meta‐analysis was to summarize (pool) data from studies on this subject and to estimate the effect of corticosteroid administration on the risk of major complications (death, heart infarction, lung problems) following heart surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Cilostazol versus aspirin for secondary prevention of vascular events after a stroke of arterial origin

Stroke is a public health problem. As lower and middle income countries make rapid economic progress they face the additional health burden of diseases of affluence like stroke and heart attacks. Unlike heart attack, stroke is a disease caused by more than one mechanism. In Asians, a larger proportion of ischaemic stroke is due to narrowing of the arteries at the base of the brain. Compared to Caucasians, Asians are more likely to have bleeds into their brain matter causing stroke, because of uncontrolled high blood pressure. The medication cilostazol thins the blood by blocking platelet accumulation and appears, from early reports, to be more effective than aspirin in the prevention of stroke, heart attacks and death from vascular causes in patients with stroke. This may be due to its inherent effectiveness, as well as chances of fewer brain bleeds. In this review of two randomised trials involving 3477 participants, we found that cilostazol was more effective for the prevention of stroke, heart attack and death from vascular causes in Asian patients with stroke. In terms of safety, it causes more side effects than aspirin but less serious bleeding in the brain and the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Banding ligation versus beta‐blockers for primary prevention in oesophageal varices in adults

Non‐selective beta‐blockers are used as a first‐line treatment for primary prevention in patients with medium‐ to high‐risk oesophageal varices. However, the effect of non‐selective beta‐blockers on mortality is debated and many patients experience adverse events. This review includes 19 randomised trials on banding ligation versus beta‐blockers for patients with high‐risk oesophageal varices and no history of bleeding. Bias control was unclear in most trials. There was no difference in mortality among the patients randomised to banding ligation compared with beta‐blockers. The trials with adequate bias control based on the assessment of randomisation methods found no difference in bleeding rates. The trials with unclear randomisation methods found that banding ligation reduced bleeding. The effect of banding ligation was associated with the duration of follow‐up and publication status of the trials. The results of trials with less than 20 months of follow‐up found a better effect of banding ligation compared to trials with longer follow‐up. Trials published in abstract form were more positive towards the effect of banding ligation than trials published as full paper articles. The combined evidence suggests that banding ligation and beta‐blockers may be used as primary prophylaxis in oesophageal varices in adult patients. Additional evidence from trials with adequate bias control and sufficient follow‐up is still needed to determine long‐term effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

No assured evidence on traditional Chinese medicine herbs (TCMHs) stopping bleeding from haemorrhoids but limited evidence on TCMHs alleviating some symptoms caused by haemorrhoids.

Haemorrhoids, one of the common perianal diseases, may easily lead to haematochezia, perianal inflammation, perianal venous prolapse or incarceration once it progresses to a serious stage. Besides surgical operation or minimally invasive treatment, a variety of Traditional Chinese Medicine herbs (TCMHs) have been used for treating bleeding haemorrhoids in many patients in China. TCMHs might be effective for this illness and provide an alternative therapeutic measure. However, our primary research for this review showed that there was no strong evidence concerning the effectiveness of TCMHs in stopping bleeding from haemorrhoids. The included studies were few and of low quality. Limited, weak evidence showed that some formulae, when including Radix Sanguisorbae, Radix Rehmanniae, Fructus Sophorae, etc., may alleviate some symptoms caused by haemorrhoids. These symptoms include hematochezia and congestive haemorrhoidal cushions, in the short term. Additional, standardised trials are needed for meta‐analysis to draw a final conclusion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Emergency sclerotherapy is not better than pharmacological therapy for acute variceal bleeding in cirrhosis

Variceal bleeding in cirrhosis is associated with a high risk of death. Although banding ligation of varices is considered the choice for endoscopic treatment, emergency sclerotherapy is frequently used particularly where ligation is not available or when it is not feasible. However, vasoactive drugs stop bleeding in most patients, and emergency sclerotherapy may carry risks to the patient and is more demanding on the health‐care system. All of the identified randomised clinical trials comparing emergency sclerotherapy with vasopressin (+/‐ intravenous or transdermal nitroglycerin), terlipressin, somatostatin, or octreotide have been reviewed. A total of 17 randomised trials including 1817 patients were included. Sclerotherapy did not appear to be superior to the vasoactive drugs in terms of control of bleeding, number of transfusions, 42‐day rebleeding and mortality, or rebleeding and mortality before other elective treatments. However, adverse events were significantly more frequent and severe with sclerotherapy than with vasoactive drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Portosystemic shunts compared with sclerotherapy/banding lowers variceal rebleeding, but increases hepatic encephalopathy

A third of deaths from cirrhosis are due to variceal bleeding. Randomised clinical trials have compared three types of portosystemic shunting separately against endoscopic therapy. The shunts included in these trials have been total portocaval shunts, distal splenorenal shunts, and transjugular intrahepatic portocaval shunts. The authors found that when compared to endoscopic therapy all three types of shunt lowered the rate of rebleeding at the cost of a higher incidence of hepatic encephalopathy, without any statistically significant difference in survival.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Somatostatin analogues for acute bleeding oesophageal varices

Cirrhosis of the liver is a chronic, progressing disease that is most commonly caused by excessive use of alcohol or by hepatitis C infection. The liver tissue is replaced by connective tissue, which leads to loss of liver function. People with cirrhosis of the liver may develop varicose veins (enlarged blood vessels or varices) in the gullet. Bleeding varices can be life‐threatening. The hormone somatostatin, or similar drugs like octreotide and vapreotide, can be used to try to stop the bleeding. The review of 21 trials (2588 patients) found that the tested drugs did not reduce deaths. There was a small reduction in the need for blood transfusions, corresponding to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Terlipressin is a safe and effective treatment for bleeding from oesophageal varices which is a life threatening complication of cirrhosis of the liver

Esophageal varices are abnormal dilatations of veins in the lower part of the swallowing tube (oesophagus) that may develop in patients with chronic liver damage (cirrhosis). Bleeding from these varices is a life threatening complication with mortality between 20 and 50 per cent. Bleeding from varices may be treated with medications and/or with an endoscope which is a flexible tube with a camera at the end which allows direct visualization and treatment of bleeding varices. The reviewers evaluated the safety and effectiveness of a drug called terlipressin: they reported that terlipressin appears to be as safe as other treatments and that terlipressin may reduce the mortality from variceal bleeding as compared to placebo. The reviewers did not have sufficient data to decide whether terlipressin was better or worse than other available treatments such as other drugs (somatostatin, octreotide) or endoscopic treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage

There is no evidence of benefit from corticosteroids for patients with stroke due to bleeding. About one fifth of all strokes are due to bursting of an artery. The burst artery causes bleeding into the brain itself (called intracerebral haemorrhage) or into the space around the brain (called subarachnoid haemorrhage). After either type of bleed the brain tissue may become swollen. The swelling causes a rise in pressure which can cause further brain damage or even death. Corticosteroids could reduce swelling after brain haemorrhage and so improve the chances of the patient recovering. However, corticosteroids can also have important adverse effects such as increased blood sugars, infection, and gastrointestinal bleeding. The trials included in this review had too few participants to provide reliable evidence on any benefits weighed against harms of this treatment for patients with stroke due to bleeding in the brain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Phenobarbital prior to preterm birth for preventing neonatal periventricular haemorrhage

Evidence does not support phenobarbital treatment to women giving birth before 34 weeks to decrease the risk of bleeding into the babies' brains.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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