From the Guidelines
Varicella-associated bleeding treatment involves prompt resuscitation and correction of coagulopathy.
Treatment Overview
- The management of bleeding anorectal varices can be challenging and requires a multidisciplinary approach, involving early hepatology specialist team intervention and optimal control of comorbid conditions 1.
- Initial resuscitation and hemodynamic stabilization are critical, with targets including restoration of hemodynamic status without over-expansion, which may exacerbate portal pressure and impair clot formation 1.
Medical Management
- Intravenous fluid replacement and blood transfusion are suggested for patients with mild bleeding, with a target hemoglobin level of 7-9 g/dl 1.
- Vasoactive drugs, such as terlipressin or octreotide, may be considered to reduce splanchnic blood flow and portal pressure, although evidence is limited to their use in esophageal varices 1.
- Non-selective beta-blockers may be used for prevention of variceal bleeding, but should be temporarily suspended in the acute setting of a hypotensive patient with bleeding anorectal varices 1.
- Prophylactic antibiotics are recommended for all patients presenting with cirrhosis and gastrointestinal bleeding, including rectal bleeding, to reduce the risk of spontaneous bacterial peritonitis 1.
Endoscopic Management
- Ano-proctoscopy or flexible sigmoidoscopy are suggested as first-line diagnostic tools for suspected bleeding anorectal varices 1.
- Urgent colonoscopy may be performed within 24 hours of presentation for patients with high-risk features or evidence of ongoing bleeding 1.
- Local procedures, such as endoscopic variceal ligation or sclerotherapy, may be used to arrest bleeding in patients with bleeding anorectal varices 1.
Non-Operative Management
- Multidisciplinary management is suggested, with early involvement of the hepatology specialist team and focus on optimal control of comorbid conditions 1.
- Endorectal placement of a compression tube may be used as a bridging maneuver to help stabilize the patient or allow transfer to a tertiary hospital 1.
From the FDA Drug Label
Intravenous acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients.
The treatment for varicella-associated bleeding is not directly addressed in the provided drug labels. However, intravenous acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients 2.
- The dosage and administration for varicella-zoster infections are not explicitly stated for bleeding complications.
- It is essential to note that varicella-associated bleeding may require additional or alternative treatments, but this information is not provided in the drug labels.
Given the lack of direct information, a conservative clinical decision would be to consult additional resources or expert opinions for guidance on treating varicella-associated bleeding. 2 2
From the Research
Varicella-Associated Bleeding Treatment
There are no research papers to assist in answering this question, as the provided study 3 focuses on acute cerebellitis in varicella, rather than varicella-associated bleeding.
- The study 3 discusses the occurrence, clinical picture, and outcome of acute cerebellitis in children hospitalized for varicella.
- It does not provide information on the treatment of varicella-associated bleeding.
- The study's findings are related to the neurological complications of varicella, specifically acute cerebellitis, and do not address bleeding complications.