Fifty-seven trials were included. Thirty trials compared vasoactive medications with placebo or standard therapy (3,111 patients) and 27 trials (2,293 patients) compared vasoactive medications with each other. Quality of evidence was rated from very low to moderate. Allocation concealment methods were not used in four studies and were not clearly described in 10 trials. The use of intention-to-treat analysis was absent from one trial and was unclear in 13 studies. Funnel plots showed no evidence of publication bias.
Mortality: Compared with control, vasoactive agents were associated with a significant reduction in risk of all-cause mortality within seven days (RR 0.74, 95% CI 0.57 to 0.95; Ι²=0%; 19 studies). A trend that favoured treatment compared to control in terms of risk of intermediate all-cause mortality at eight to 42 days was not statistically significant (RR 0.80, 95% CI 0.64 to 1.00; Ι²=21%; 20 studies). The overall quality of the evidence was rated as moderate.
Other outcomes: Vasoactive agents were associated with a statistically significant increase in haemostasis (RR 1.21, 95% CI 1.13 to 1.30; Ι²=27%; 25 studies), the overall quality of this evidence was classed as very low. Risk of re-bleeding was statistically significantly lower for patients who received the intervention (RR 0.68; 95% CI 0.52 to 0.90; Ι²=41%; 16 studies), the overall quality of this evidence was classed as low.
Patients who received vasoactive medications had transfusion requirements that were statistically significantly lower than control (-0.70 units of blood, 95% CI -1.01 to -0.38; Ι²=82%; 21 studies). The quality of this evidence was classed as moderate.
Length of hospital stay was lower for patients treated with vasoactive agents, and the difference with control was statistically significant (MD -0.71 days; 95% CI -1.23 to -0.19; Ι²=0%; four studies). The quality of the evidence was rated as low. Results of subgroup analyses were reported.
Comparisons between vasoactive treatments: No difference in mortality or re-bleeding was found between vasoactive treatments. Haemostasis was significantly greater in patients treated with octreotide compared with vasopressin (RR 1.31; 95% CI 1.10 to 1.56; two studies) and significantly lower with vasopressin compared to somatostatin (RR 0.75, 95% CI 0.61 to 0.92; six studies).