Continuous infusion of pantoprazole with octreotide does not improve management of variceal hemorrhage

Study Objective. To assess the effect of a prolonged continuous infusion of pantoprazole on patient outcomes when the drug was combined with standard octreotide therapy in patients with variceal hemorrhage. Design. Retrospective cohort study Setting. Large academic hospital. Patients. One hundred thirty adults who received treatment for a documented variceal hemorrhage; 53 patients received standard octreotide therapy plus a prolonged continuous infusion of pantoprazole (continuous-infusion group) and 77 patients received either octreotide alone, octreotide with a short-term (< 24 hrs) infusion of pantoprazole, or octreotide with intermittent acid suppression (control group). Measurements and Main Results. The primary outcome measure was the number of units of packed red blood cells transfused during hospitalization. Baseline characteristics between the treatment groups were similar. The duration of therapy for variceal hemorrhage was significantly longer in the continuous-infusion group than in the control group. Transfusion requirements for packed red blood cells (mean ± SD 6.4 ± 6.5 vs 5.8 ± 6.6 units, p=0.66) and platelets (8.8 ± 15.1 vs 5.1 ± 11.9 units, p=0.13) were similar for the continuous-infusion group versus the control group. The continuous-infusion group, however, received significantly more units of fresh-frozen plasma than the control group (6.1 ± 10.6 vs 2.9 ± 6.2 units, p=0.05). There was no significant difference in mortality rate between groups. Conclusion. Prolonged continuous infusions of pantoprazole with octreotide seemed to offer no additional benefit compared with octreotide plus short-term infusions of pantoprazole or intermittent acid suppression in the management of acute variceal hemorrhage. Prospective studies should be conducted to evaluate the role of continuously infused proton pump inhibitors in this setting before their use can be advocated.