I have seen well respected clinicians provide a patient with a gastrointestinal (GI) bleed with high doses of systemic vasopressin. Throughout my three years of residency training and two years of fellowship at a well respected institution, I have not seen this used once in practice. Let’s take a look at what this really means and whether or not it actually works per the data. Being fully transparent as I always try to be, my bias is that it does not work.
Why are we even looking at Vasopressin in a GI Bleed?
It is known since 1928 that vasopressin increases hepatic arterial pressure and lowers portal venous pressure. This can decrease the bleeding when it does occur.
What does the data say regarding Vasopressin and GI Bleeds?
In 1975, Conn et al. published a prospective, controlled, clinical trial where they injected intraarterial vasopressin versus conventional treatment in patients with an upper GI bleeds. This worked in these patients, the vasopressin worked, but did you catch the key word of “intraarterial”? In this paper the intraarterial vasopressin in the angio suite. Today, our friendly neighborhood interventional radiologists could do this for us but chances are that they’ll coil the lesions and be done with it. The rate, for those curious was between 0.05 to 0.2 U/min. Other similar papers were published in the 1970’s looking at this concept.
Hussey published a review in 1985 where he looked at four clinical studies using vasopressin in a GI bleed. He stated “vasopressin has failed to change the mortality in patients with acute upper gastrointestinal tract hemorrhage, and it is associated with significant side effects”.
This is a work in progress and will finish this post sometime this weekend, I hope about using vasopressin in a GI bleed.
CLICK HERE for a larger review of all thing Vasopressors (work in progress).
Citations looking at GI Bleed and Vasopressin
Osman D, Djibré M, Da Silva D, Goulenok C; group of experts. Management by the intensivist of gastrointestinal bleeding in adults and children. Ann Intensive Care. 2012 Nov 9;2(1):46. doi: 10.1186/2110-5820-2-46. PMID: 23140348; PMCID: PMC3526517.
Link to Article
Link to FULL FREE PDF
Stump DL, Hardin TC. The use of vasopressin in the treatment of upper gastrointestinal haemorrhage. Drugs. 1990 Jan;39(1):38-53. doi: 10.2165/00003495-199039010-00004. PMID: 2178911.
Link to Article
Goldsmith SR. Vasopressin as vasopressor. Am J Med. 1987 Jun;82(6):1213-9. doi: 10.1016/0002-9343(87)90228-2. PMID: 3300305.
Link to Article
Hussey KP. Vasopressin therapy for upper gastrointestinal tract hemorrhage. Has its efficacy been proven? Arch Intern Med. 1985 Jul;145(7):1263-7. PMID: 3893345.
Link to Article
Conn HO, Ramsby GR, Storer EH, Mutchnick MG, Joshi PH, Phillips MM, Cohen GA, Fields GN, Petroski D. Intraarterial vasopressin in the treatment of upper gastrointestinal hemorrhage: a prospective, controlled clinical trial. Gastroenterology. 1975 Feb;68(2):211-21. PMID: 803910.
Link to Article
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