Scenario: You are the consultant for General Medicine/GI. A
middle-aged male is admitted with suspected acute variceal hemorrhage.
You ask yourself, "In a middle-aged male with suspected AVH, does
giving octreotide/somatostatin improve likelihood of survival, reduce blood
loss, and reduce the likelihood of rebleeding?"
Evidence: Being true EBMer you go to your 'evidence cart' and look
quickly at the Cochrane. Yipee and whew! There is one SR that is
perfectly applicable comparing octreo/somatostatin to placebo or no
treatement in AVH. Scanning the results, you see that the OR for
survival is 1.04 (95%CI 0.74 to 1.46). Average (weighted) number of
transfusions saved with octreo/somato was 1.2 (95% CI 0.8-1.6).
The secondary endpoints were heterogeneous in the studies included in
the meta-analysis: Use of balloon tamponade OR=0.59 (CI 0.21 to 1.70);
patient failing initial hemostaisis OR 0.66 (CI 0.32 to 1.37), rebleeding
OR=0.73 (CI 0.30 to 1.79).
Now, what are you going to do? Give octreo/somato or not? What is
current practice in your institution?
I would value your response & interpretation of these results.
Thanks,
Janet Martin, PharmD
Evidence-Based Prescribing Guidelines Pharmacist
London Health Sciences Centre
London, Ontario, Canada
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