A Cochrane review [Abstract] 1 included 21 studies with a total of 2 588 subjects. The drugs did not significantly reduce mortality (relative risk 0.97, 95% confidence interval 0.75 to 1.25, for the high-quality trials, and 0.80 for low-quality trials). Units of blood transfused were 0.7 (0.2 to 1.1) less with drugs in the high-quality trials and 1.5 (0.9 to 2.0) less in the low-quality trials. Number of patients failing initial haemostasis was reduced (RR 0.68, 95% CI 0.54 to 0.87). Number of patients with rebleeding was not significantly reduced for the high-quality trials (RR 0.84, 95% CI 0.52 to 1.37) while it was substantially reduced in the low-quality trials (RR 0.36, 95% CI 0.19 to 0.68). Use of balloon tamponade was rarely reported.
Another systematic review 2 including 14 RCTs with a total of 1,829 subjects was abstracted in DARE. Somatostatin reduced the relative risk of bleeding or rebleeding to 0.53 (95% CI 0.43 to 0.63, NNT = 5). Somatostatin or octreotide showed a tendency to be more effective for peptic ulcer bleeding (RR 0.48, 95% CI 0.39 to 0.59) than non-peptic ulcer bleeding (relative risk 0.62, 95% CI 0.39 to 1.002).
A third systematic review 3 including 6 studies with a total of 275 subjects was abstracted in DARE. The risk ratio of achieving initial control of bleeding with somatostatin compared with vasoperessin was 1.62 (95% CI 1.37 to 1.93, NNT 3.7). The risk ratio of achieving sustained control of bleeding with somatostatin compared with vasopressin was 1.28 (95% CI 1.00 to 1.65, NNT 8.8). The risk of adverse effects requiring discontinuation of treatment was greater with vasopressin (10% vs 0%)
Primary/Secondary Keywords