No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment

Hung, Tsung–Hsing; Tsai, Chen–Chi; Tseng, Chih‐Wei; Tseng, Kuo‐Chih; Hsieh, Yu–Hsi; Tsai, Chen-Chi

doi:10.1097/meg.0000000000000703

Cited by 10 publications

(9 citation statements)

References 30 publications

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Section: Terlipressin For the Management Of Variceal Bleedingmentioning

confidence: 99%

“…With this early data suggesting a greater effect of terlipressin over octreotide at reducing variceal pressure, several studies have attempted to demonstrate this benefit on clinically significant endpoints. [38][39][40][41][42] A recent, large RCT assessed the outcomes of patients presenting with variceal bleeding with adjuvant treatment with either terlipressin, somastostatin, or ocreotide. 43 Seven hundred and eighty patients presenting with variceal hemorrhage were enrolled across 11 Korean centers and were commenced on either Terlipressin [2 mg bolus then 1 mg q.i.d.…”

Section: Terlipressin For the Management Of Variceal Bleedingmentioning

confidence: 99%

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Terlipressin: Current and emerging indications in chronic liver disease

Papaluca

Gow

2018

J of Gastro and Hepatol

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Terlipressin is an analogue of vasopressin that has potent vasoactive properties and has been available for use in most countries for nearly two decades. It has both established roles and emerging indications in the management of complications of decompensated chronic liver disease. We explore historic and emerging literature regarding the use of terlipressin for a range of indications including hepatorenal syndrome, portal hypertensive bleeding, and disruptions in sodium homeostasis. Novel methods of infusion-based terlipressin administration including the beneficial effect in reduction of adverse events are explored, in addition to new indications for the use of terlipressin in decompensated cirrhosis in an outpatient setting.Terlipressin is an analogue of vasopressin that has potent vasoactive properties and has been available for use in most countries worldwide for nearly two decades. Terlipressin acts through the V1a receptors, which are located predominately on vascular smooth muscle within the splanchnic circulation, resulting in splanchnic vasoconstriction.1 The terlipressin-induced splanchnic vasoconstriction gives rise to increased renal blood flow and has beneficial effects on hepatorenal syndrome (HRS) while at the same time reducing portal pressure and playing a role in reducing the risk of portal hypertensive bleeding.These unique effects of the drug have translated into terlipressin playing a crucial role in the management of HRS and variceal bleeding for many years. Over more recent times, there has been an expansion of the indications for terlipressin usage and a broadening in the methods available for drug delivery. Its established roles and emerging indications will be examined in this review.

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Section: Terlipressin For the Management Of Variceal Bleedingmentioning

confidence: 99%

Section: Terlipressin For the Management Of Variceal Bleedingmentioning

confidence: 99%

Terlipressin: Current and emerging indications in chronic liver disease

Papaluca

Gow

2018

J of Gastro and Hepatol

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“…Additionally, one previous retrospective study from Taiwan reported that 30-day mortality was non-significantly higher in cirrhotic patients with esophageal variceal bleeding and renal function impairment receiving somatostatin than those receiving terlipressin (52.6% vs. 42.3%). However, the change of renal function parameters was not evaluated (7). By comparison, our study focused on the change of Cr and CysC values after terlipressin in such patients.…”

Section: Prior Studiesmentioning

confidence: 99%

“…This is primarily associated with systemic vascular resistance reduction secondary to splanchnic arterial vasodilatation in cirrhotic portal hypertension (4) and renal perfusion reduction secondary to blood loss after gastrointestinal bleeding (5,6). On the other hand, renal dysfunction significantly decreases the survival of cirrhotic patients (7,8).…”

Section: Introductionmentioning

confidence: 99%

Effect of terlipressin on renal function in cirrhotic patients with acute upper gastrointestinal bleeding

Zhang¹,

Liu²,

Wu³

et al. 2020

Ann Transl Med

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Background: Renal dysfunction is a serious morbidity in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB). Terlipressin is the first-line treatment choice for acute variceal bleeding and hepatorenal syndrome (HRS). This study aimed to assess the effect of terlipressin on renal function in patients with liver cirrhosis and AUGIB.Methods: We retrospectively reviewed 40 cirrhotic patients with AUGIB treated with terlipressin by an attending physician between January 2016 and June 2018. We analyzed the change of renal function parameters, including cystatin C (CysC) and creatinine (Cr), during the use of terlipressin and after terlipressin was stopped. We also identified the factors associated with renal function improvement in patients without active bleeding during the use of terlipressin.Results: During the use of terlipressin, CysC value was significantly reduced (1.3±0.8 vs. 1.1±0.7, P=0.001); Cr value was reduced, but the reduction was not statistically significant (68.8±24 vs. 65.5±23, P=0.817); the rate of CysC reduction was significantly higher in patients treated with terlipressin than those treated with somatostatin/octreotide (73.1% vs. 0%, P=0.005); the rate of Cr reduction was not significantly different between patients treated with terlipressin and somatostatin/octreotide (61.5% vs. 20%, P=0.148); no factor associated with CysC reduction was identified; higher hemoglobin, red blood cell, and platelet and lower prothrombin time and international normalized ratio at baseline were significantly associated with Cr reduction. After terlipressin was stopped, neither CysC nor Cr value was significantly reduced (P=0.852 and P=0.296).Conclusions: Terlipressin may be beneficial on preventing renal function impairment in cirrhotic patients with AUGIB.

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“…Terlipressin treatment is preferred due to it is the only one to have shown a reduction in mortality [40]. However, recent studies observed similar results in both treatments in oesophageal varices as well as gastric varices [41,42]. Both treatments should be started promptly if variceal bleeding is suspected and continued after endoscopy for at In addition, cirrhotic patients with variceal bleeding which have sepsis on admission, should be also treated with antibiotic.…”

Section: Pharmacotherapy For Variceal Bleedingmentioning

confidence: 99%

Management of acute upper gastrointestinal bleeding

Esteban‐Zubero¹,

Sarmiento-Acosta²,

Sáez-Jiménez³

et al. 2018

Ann Gastroenterol Dig Syst

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The purpose of this review is to summarize the management of upper gastrointestinal bleeding (UGIB). This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality rate of 10% to 14%. Classically, UGIB is divided in non-variceal hemorrhage and variceal hemorrhage, being more frequently observed the first one (80%-90%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, endoscopy, alcohol intake, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding. To stratify these patients, risk scores including Blatchford score and Rockall score are developed.Diagnosis is realized through endscopy, which allows definitive treatment. This treatment is improved providing pre-endoscopy as well as post-endoscopy therapy, including proton pump inhibitor (PPI) therapy. In variceal hemorrhage, if endoscopy therapy fails, balloon tamponade or transjugular intrahepatic portosystemic shunt (TIPSS) are indicated.The purpose of this review is to summarize the initial management of acute UGIB, especially in the Emergency Department.

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No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment

Cited by 10 publications

References 30 publications

Terlipressin: Current and emerging indications in chronic liver disease

Terlipressin: Current and emerging indications in chronic liver disease

Effect of terlipressin on renal function in cirrhotic patients with acute upper gastrointestinal bleeding

Management of acute upper gastrointestinal bleeding

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