From the Research
Yes, you should hold hydrochlorothiazide (HCTZ) in a patient with a query upper GI bleed. HCTZ is a thiazide diuretic that can potentially worsen outcomes in active bleeding by contributing to hypotension through its volume-depleting effects. In the setting of an upper GI bleed, maintaining adequate blood pressure and organ perfusion is critical, and continuing HCTZ could counteract these goals by promoting further volume depletion. Additionally, the medication doesn't provide any benefit in the acute management of GI bleeding.
According to the most recent and highest quality study 1, the management of upper GI bleeding involves risk assessment, endoscopy, and the use of proton pump inhibitors, but does not mention the use of diuretics like HCTZ. In fact, a study from 2 suggests that diuretic use may be associated with an increased risk of gastrointestinal bleeding.
Once the bleeding is controlled and the patient is hemodynamically stable with adequate volume resuscitation, you can reassess whether to restart HCTZ based on the patient's blood pressure and overall clinical status. During this time, monitor the patient's blood pressure closely, as some patients may experience rebound hypertension when HCTZ is temporarily discontinued. The decision to restart should consider the patient's underlying hypertension severity, other antihypertensive medications they may be taking, and their volume status after the bleeding episode has resolved.
Key considerations in the management of upper GI bleeding include:
- Maintaining adequate blood pressure and organ perfusion
- Risk assessment using tools like the Glasgow-Blatchford score
- Endoscopy within 24 hours of presentation
- Use of proton pump inhibitors
- Monitoring for recurrent bleeding and addressing risk factors.
It's essential to prioritize the patient's hemodynamic stability and overall clinical status when deciding whether to hold or restart HCTZ in the setting of a query upper GI bleed, as supported by studies like 3, 4, and 5.