Choosing the Right Vasoactive Agent in Acute Variceal Bleeding in Cirrhotic Patients: A Review of Terlipressin vs. Octreotide Outcomes.

This systematic review evaluates and compares the clinical effectiveness of terlipressin and octreotide in the management of acute gastroesophageal variceal bleeding among cirrhotic patients. A comprehensive literature search was conducted across PubMed, Google Scholar, and clinical trial registries, identifying five randomized controlled trials that met predefined inclusion criteria. These studies assessed key outcomes, including bleeding control, mortality, hepatic venous pressure gradient (HVPG) reduction, hemodynamic stability, and safety profiles. The findings demonstrated that both agents are effective in controlling variceal bleeding, with no major differences in short-term mortality. However, terlipressin was associated with sustained HVPG reduction, more durable hemodynamic effects, and, in some cases, shorter hospital stays. In alcoholic cirrhosis subgroups, terlipressin showed a superior portal pressure response. Risk of bias assessments indicated generally low-to-moderate concerns across studies, supporting the reliability of findings. This review highlights terlipressin's potential advantages in specific clinical contexts and underscores the need for further large-scale trials to refine therapy selection and optimize patient outcomes.