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

BACKGROUND: In acute variceal hemorrhage (AVH), guidelines recommend 2 to 5 days of octreotide following endoscopic hemostasis to reduce early rebleeding; however, the optimal duration of therapy remains undefined. OBJECTIVE: To evaluate whether a shorter duration of octreotide therapy is non-inferior to a longer duration in preventing early rebleeding and adverse clinical outcomes. METHODS: This multicenter, retrospective non-inferiority study included adults with cirrhosis and endoscopically confirmed AVH admitted to 13 hospitals within the Cleveland Clinic Health System between January 2020 and August 2024. Patients were categorized by post-endoscopic octreotide infusion duration: short-course (≤72 h) or long-course (>72 h). The primary outcome was 5-day rebleeding, with a prespecified non-inferiority margin of 15%. Secondary outcomes included 48-hour rebleeding, transfusion requirements, in-hospital mortality, adverse events, and octreotide-related costs. RESULTS: Among 260 patients, 131 received short-course and 129 received long-course octreotide therapy. Rebleeding within 5 days occurred in 27.5% and 31.0% of patients, respectively (absolute risk difference = -3.5%; 95% confidence interval = -14.6% to 7.5%), meeting the non-inferiority threshold. Secondary outcomes were similar: 48-hour rebleeding (17.6% vs 20.2%), median blood transfusion (0 vs 0 units), and in-hospital mortality (10.7% vs 18.6%). Rates of bradycardia, hypo- or hyperglycemia, and ileus did not differ. Octreotide-related treatment costs were significantly lower in the short-course group. CONCLUSION AND RELEVANCE: In patients with AVH who achieved endoscopic hemostasis, short-course octreotide therapy was non-inferior to longer-course therapy in preventing early rebleeding, with similar clinical outcomes and lower treatment cost.