Rational for Continuing Terlipressin After Endoscopic Variceal Ligation in Acute Variceal Haemorrhage Needs Further Evidence: A Pilot Study

Abstract

Background Variceal hemorrhage (VH) is a medical emergency. Prompt endoscopic variceal ligation (EVL) is therapeutic. Terlipressin is used in VH and continued for 2—5 days even after EVL. As hemostasis is primarily achieved by EVL, the benefit of continuing trelipressin after EVL is unknown. Objective To evaluate the efficacy of continuing terlipressin after EVL to prevent re-bleed and mortality. Methods In this pilot study, after EVL 74 patients of VH were randomized into two treatment groups TG2 & TG5, received terlipressin (1 mg IV bolus q 4 hourly) for 2 days and 5 days respectively and one control group (TG0), received 0.9% normal saline (10 mL IV bolus q 4 hourly) and followed up for 8 weeks. Results A total of 9 (12.6%) patients had re-bleed with maximum 4 (5.6%) patients in TG5 group followed by 3 (4.2%) in TG2 and 2 (2.8%) in TG0 groups (P=0.670). The overall mortality was 15 (21.1%) patients, 6 (8.5%) patients in TG0 group, followed by 5 (7.0%) in TG5 and 4 (5.6%) in TG2 group (P=0.691). Adverse drug reactions were significantly higher in treatment groups with maximum 18 (24.32%) patients in TG5, followed by 8 (10.8%) in TG2 and 2 (2.7%) in TG0 groups (P=0.00). Duration of hospital stay was also significantly higher in treatment group, 6.63 (±0.65) days in TG5 followed by 3.64 (±0.57) in TG2 and 2.40 (±0.50) days in TG0 groups (P=0.00). Conclusion The rational for continuing terlipressin after EVL is doubtful as it didn’t have any benefit for the prevention of re-bleed or mortality; rather it increased the risk of adverse drug reactions and duration of hospital stay. Further randomized clinical trials are encouraged to generate more evidence in support or against continuing terlipressin after EVL.

Improvement of gut-vascular barrier by terlipressin reduces bacterial translocation and remote organ injuries in gut-derived sepsis

“…Terlipressin, a highly selective vasopressin V1 receptor agonist, has become one of the commonly used vasoconstrictor drugs in the operating room and intensive care unit (ICU), and it successfully used in cases of septic shock (O'Brien, Clapp et al, 2002), hepatorenal syndrome (Uriz, Ginès et al, 2000), and gastrointestinal bleeding (Favalli, De Franceschi et al, 2004). Moreover, several clinical experiments are now investigating the impact of terlipressin on variceal hemorrhage (Poudel, Dhibar et al, 2022), post-hepatectomy (Li et al, 2020b), cirrhosis and ascites (Israelsen, Dahl et al, 2020). In our multicenter clinical trial, terlipressin effectively maintained the stability of circulation in the patients with septic shock (Liu, Chen et al, 2018).…”