![]() Treat patients who are taking warfarin and whose upper gastrointestinal bleeding has stopped in line with local warfarin protocols (level 5, grade D). Offer prothrombin complex concentrate to patients who are taking warfarin and actively bleeding (level 5, grade D). Dose titrated to maximum tolerated or once HR of 50–55 bpm is reached a maximum dose of 240 mg (level 1a, grade A).Ĭarvedilol: 6.25 mg once daily to increase to maintenance of 12.5 mg after a week if tolerated or once HR of 1.5 times normal (level 5, grade D). Dose titrated to maximum tolerated or once heart rate (HR) of 50–55 bpm is reached to a maximum dose of 320 mg (level 1a, grade A). We suggest carvedilol or nadolol as alternatives to propranolol (level 1b, grade A). The choice of VBL or NSBB should also take into account patient choice (level 1a, grade A). VBL is offered if there are contraindications to NSBB. We suggest pharmacological treatment with propranolol as first line. ![]() We recommend non-cardioselective β blockers (NSBB) or variceal band ligation (VBL). What is the best method for primary prophylaxis? Recommendations: primary prophylaxis of variceal haemorrhage in cirrhosis ( Figure 2) They are not designed to deal with (1) the management of the underlying liver disease (2) the management of variceal haemorrhage in children or (3) variceal haemorrhage from other aetiological conditions. These guidelines deal specifically with the management of varices in patients with cirrhosis under the following subheadings: (1) primary prophylaxis (2) acute variceal haemorrhage (3) secondary prophylaxis of variceal haemorrhage and (4) gastric varices. ![]() The nature of variceal haemorrhage in cirrhotic patients with its complex range of complications makes rigid guidelines inappropriate. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. ![]()
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