VOCAL-Penn Score for Variceal Rebleeding
Predicts 6-week rebleeding and mortality risk after acute oesophageal variceal haemorrhage to guide intensity of follow-up and secondary prophylaxis.
Score interpretation
VOCAL-Penn low risk: < 10% 6-week rebleeding and mortality risk.
→ Standard variceal band ligation (EVL) secondary prophylaxis. Non-selective beta-blocker (NSBB: propranolol or carvedilol) within 5 days of haemostasis. Repeat EVL every 4–8 weeks until variceal obliteration. Repeat OGD 1–3 months post-obliteration.
VOCAL-Penn intermediate risk: 10–30% 6-week rebleeding/mortality.
→ EVL + NSBB combination. Consider pre-emptive TIPS (transjugular intrahepatic portosystemic shunt) if Child-Pugh B/C and haemostasis achieved. Early hepatology and hepatobiliary surgery review. Monitor closely for signs of rebleeding.
VOCAL-Penn high risk: > 30% 6-week rebleeding and mortality. Consider pre-emptive TIPS.
→ Pre-emptive TIPS within 72 hours (ideally < 24h) of haemostasis (EASL recommends for Child-Pugh B with active bleeding or Child-Pugh C). Vasoconstrictor (terlipressin/somatostatin) continued until TIPS. Antibiotics (ceftriaxone 1g/day × 7 days). Intensive monitoring. Liver transplant assessment if eligible.
Interpretation bands for the VOCAL-Penn. Apply clinical judgement and local guidance.
References
- Reverter E et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology. 2014.
- EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol. 2022.
Related
Curated clinical cross-links plus same-class fallbacks.
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Propranolol (Portal Hypertension) · Antihypertensive
- Carvedilol (Portal Hypertension) · Non-Selective Beta-Blocker with Alpha₁-Blocking Activity
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Spironolactone (Ascites / Cirrhosis) · Aldosterone Antagonist / Potassium-Sparing Diuretic
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.