Lower Gastrointestinal Bleeding Medication

Updated: Jul 26, 2019
  • Author: Burt Cagir, MD, FACS; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

Vasoconstrictive agents reduce the blood flow and facilitate hemostatic plug formation in the bleeding vessel. However, the results are less than satisfactory in patients with severe atherosclerosis and coagulopathy.

In patients on anticoagulant agents, a multidisciplinary team approach is indicated for decision making regarding discontinuing these agents or using reversal agents to weigh the risks of ongoing hemorrhage with the potential for thromboembolic events. [5]  In patients on dual antiplatelet therapy or monotherapy with nonaspirin antiplatelet agents (thienopyridine), resume non-aspirin antiplatelet therapy as soon as possible and at least within 7 days following multidisciplinary assessment of cardiovascular and GI risk and the adequacy of endoscopic therapy. Do not discontinue dual antiplatelet therapy in individuals with an acute coronary syndrome within the past 90 days or coronary stenting within the past 30 days. [5]

Avoid the use of nonsteroidal anti-inflammatory agents in patients with a history of acute lower gastrointestinal (GI) bleeding (LGIB), such as from diverticular disease or angioectasia. [5] Do not discontinue aspirin as secondary prophylaxis in those who have high-risk cardiovascular disease and a history of LGIB; however, avoid the use of aspirin for primary prevention of cardiovascular events in most patients with LGIB. [5]

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Posterior Pituitary Hormones

Class Summary

Agents with vasopressor and antidiuretic hormone (ADH) activity may reduce lower gastrointestinal bleeding.

Vasopressin (Pitressin Injection)

Vasopressin is a pituitary hormone that causes severe vasoconstriction in the splanchnic bed. This agent has vasopressor and ADH activity: Vasopressin increases water resorption at the distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout the vascular bed of the renal tubular epithelium (vasopressor effects). However, vasoconstriction also increases in the splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.

Vasopressin decreases the portal pressure in portal hypertension. A notable undesirable effect is coronary artery constriction that may dispose patients with coronary artery disease to cardiac ischemia. This can be prevented with concurrent use of nitrates.

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Adrenergic Agonists

Class Summary

Epinephrine can be used in lower gastrointestinal bleeding, causing vasoconstriction and physical compression of the vessel. Epinephrine may be used in cases of diverticular bleeding or postpolypectomy hemorrhage.

Epinephrine

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects. Epinephrine solution (1/10,000 ) can be injected into the bleeding site at the time of the endoscopic evaluation.

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