Impact of Octreotide Infusion Duration on Hemostasis in Patients With Acute Variceal Hemorrhage

Introduction: In patients with acute variceal hemorrhage (AVH), current guidelines recommend treatment with octreotide for 2 - 5 days after initial hemostasis on endoscopy to reduce the risk of rebleeding. However, the optimal duration of octreotide is unknown. The goal of this study is to evaluate the association between octreotide duration and clinical outcomes to determine a dosing strategy that balances efficacy, safety, and resource utilization.


Methods: This was a multicenter, retrospective non-inferiority study evaluating adult patients with cirrhosis and AVH admitted to 13 hospitals in the Cleveland Clinic Health System from January 2020 through August 2024. Study groups included patients receiving octreotide for ≤ 72 hours (short-course) or > 72 hours (long-course) after hemostasis on endoscopy. The primary outcome was the rate of rebleeding at 5 days. The prespecified non-inferiority margin was set at 15%. Secondary outcomes included blood transfusion requirement, rate of rebleeding at 48 hours, in-hospital mortality, incidence of adverse events, and treatment cost.


Results: Of the 260 patients included, 131 patients received short-course octreotide, and 129 patients received long-course octreotide after hemostasis on endoscopy. Thirty-six patients (27.5%) in the short-course group experienced the primary outcome, compared with 40 patients (31.0%) in the long-course group (absolute risk difference [ARD] = -3.5%; 95% confidence interval [CI] -14.6% to 7.5%); this met the threshold for non-inferiority. Secondary efficacy outcomes were similar between groups: rebleeding at 48 hours (17.6% vs. 20.2%), blood transfusion requirement (median 0 vs. 0 units), and in-hospital mortality (10.7% vs. 18.6%). The incidence of bradycardia, hypoglycemia, hyperglycemia, and ileus was similar between the two groups. In the short-course group, the cost of octreotide was significantly lower compared to the long-course group.


Conclusions: In patients with AVH, a short-course infusion was non-inferior to a long-course infusion of octreotide for the prevention of rebleeding. There were no significant between-group differences in the blood transfusion requirement, rate of rebleeding at 48 hours, in-hospital mortality, or adverse events. Treatment costs were significantly lower with short course octreotide.