Randomized controlled trial of desmopressin plus terlipressin vs. terlipressin alone for the treatment of acute variceal hemorrhage in cirrhotic patients: A multicenter, double-blind study

R, de Franchis; Pg, Arcidiacono; Carpinelli, Luca; Andreoni, B.; Cestari, L. A.; Brunati, Sergio; Zambelli, A.; Battaglia, Giuseppe; Pm, Mannucci

doi:10.1016/0270-9139(93)90464-x

Cited by 35 publications

(31 citation statements)

References 9 publications

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“…This is probably due to the increase in von Willebrand factor (vWF) and FVIII seen after administration of DDAVP which possibly compensates for the thrombocytopenia. However, de Franchis et al [8] showed that in LC patients with active variceal hemorrhage, on treatment with terlipressin, recurrence of bleeding occurred more frequently in patients who received desmopressin compared to those who did not (54% vs. 27%, respectively). In addition, desmopressin did not reduce the transfusion requirement in patients undergoing hepatectomy [9].…”

Section: Bleeding Timementioning

confidence: 95%

“…The poor association of BT as risk factor for bleeding in cirrhosis is supported by interventional studies with drugs that increase platelet vascular adherence and activation [6][7][8][9]. Thus, treatment with desmopressin (DDAVP), a synthetic peptide homologous to human vasopressin that is usually employed in congenital bleeding disorders such as von Willebrand's disease, was able to shorten the prolonged BT in patients with cirrhosis [6,7].…”

Section: Bleeding Timementioning

confidence: 98%

“…Laboratory tests of platelet function consistently show that primary haemostasis is impaired in cirrhosis as a consequence of reduced platelet function and/or low platelet count [5]. Such changes have been considered particularly relevant in the bleeding complications that occur in cirrhosis, so that the clinical effect of drugs that improve platelet function [6][7][8][9], or number of platelets [10] has been investigated in cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Violi

Basili

Raparelli

et al. 2011

Journal of Hepatology

157

162

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Patients with cirrhosis can have abnormalities in laboratory tests reflecting changes in primary haemostasis, including bleeding time, platelet function tests, markers of platelet activation, and platelet count. Such changes have been considered particularly relevant in the bleeding complications that occur in cirrhosis. However, several studies have shown that routine diagnostic tests, such as platelet count, bleeding time, PFA-100, thromboelastography are not clinically useful to stratify bleeding risk in patients with cirrhosis. Moreover, treatments used to increase platelet count or to modulate platelet function could potentially do harm. Consequently the optimal management of bleeding complications is still a matter of discussion. Moreover, in the last two decades there has been an increased recognition that not only bleeding but also thrombosis complicates the clinical course of cirrhosis. Thus, we performed a literature search looking at publications studying both qualitative and quantitative aspects of platelet function to verify which primary haemostasis defects occur in cirrhosis. In addition, we evaluated the contribution of qualitative and quantitative aspects of platelet function to the clinical outcome in cirrhosis and their therapeutic management according to the data available in the literature. From the detailed analysis of the literature, it appears clear that primary haemostasis may not be defective in cirrhosis, and a low platelet count should not necessarily be considered as an automatic index of an increased risk of bleeding. Conversely, caution should be observed in patients with severe thrombocytopenia where its correction is advised if bleeding occurs and before invasive diagnostic and therapeutic procedures.

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Section: Bleeding Timementioning

confidence: 95%

Section: Bleeding Timementioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Violi

Basili

Raparelli

et al. 2011

Journal of Hepatology

157

162

View full text Add to dashboard Cite

show abstract

“…Subsequent intervention studies report that the treatment with desmopressin (either intravenously or subcutaneously) is able to shorten the prolonged BT in patients with cirrhosis [15][16][17], thus supporting the hypothesis that the BT may play a role in increased risk of bleeding. However, further studies with clinical end points show that the addition of desmopressin to standard treatment neither decrease variceal bleeding [18], nor transfusion requirement in patients undergoing hepatectomy [19], thus casting doubts on the value of the BT prolongation in predicting the risk of bleeding. Finally, a recent study of platelet adhesion in cirrhosis, evaluated under flow conditions, finds that high levels of VWF, which is a typical feature of patients with cirrhosis, contribute to the induction of primary hemostasis [20].…”

Section: Primary Hemostasis In Chronic Liver Diseasementioning

confidence: 98%

Abnormalities of hemostasis and bleeding in chronic liver disease: the paradigm is challenged

2009

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Chronic liver disease is characterized by a global hemostatic defect including platelet-vessel wall interaction (primary hemostasis), coagulation and fibrinolysis that may cause abnormalities of the relevant laboratory tests. The causal relationship between abnormal tests and bleeding has been widely accepted, despite the fact that abnormal tests are poorly associated with the timing and incidence of actual bleeding. In this article, we review recent evidence from the literature that disputes the above paradigm, and opens new venues for laboratory/clinical research and patient management in this field.

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“…Although DDAVP is widely used, and has been shown to correct bleeding time [53], the hemostatic effects in patients with liver disease are questionable. Several studies showed no effect of DDVAP on variceal bleeding or on blood loss in patients undergoing hepatectomy or liver transplantation, indicating that correction of the bleeding time may not necessarily result in improvement of hemostasis [54,55,56]. The use of antifibrinolytic agents in these patients seems justified in view of the substantial reduction in blood loss in patients undergoing liver transplantation receiving either aprotinin or ε-aminocaproic acid [57, 58].…”

Section: Treatment Of Hemostatic Abnormalities In Patients With Livermentioning

confidence: 99%

Hemostatic Alterations in Liver Disease: A Review on Pathophysiology, Clinical Consequences, and Treatment

2007

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In most patients with acute or chronic liver failure, extensive changes in all pathways contributing to hemostasis are found. These hemostatic alterations concern both pro- and antihemostatic pathways, and therefore the net result of the hemostatic dysbalance is unclear. Although it is generally believed that patients with liver disease have a hemostasis-related bleeding tendency, this concept is challenged in recent literature. Although the bleeding problems in patients with liver disease are obvious, the clinically most relevant bleeding episodes, i.e., bleeding from ruptured varices or ulcers, are due to vascular abnormalities and portal hypertension, and not to an abnormal hemostatic system. Moreover, patients with liver disease sometimes experience thrombosis of the portal vein or hepatic artery, which is in part attributed to hypercoagulation. In addition, a substantial part of the patients with liver disease undergoing liver transplantation can nowadays undergo this major surgical procedure, which involves significant hemostatic challenges, without transfusion of blood products. Therefore, the recent debate on the presence of a major hemostatic defect in patients with liver disease seems justified. This paper will review the hemostatic changes that occur in acute and chronic liver failure, and will review hemostasis testing and reversal of coagulopathy in these patients.

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Randomized controlled trial of desmopressin plus terlipressin vs. terlipressin alone for the treatment of acute variceal hemorrhage in cirrhotic patients: A multicenter, double-blind study

Cited by 35 publications

References 9 publications

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction?

Abnormalities of hemostasis and bleeding in chronic liver disease: the paradigm is challenged

Hemostatic Alterations in Liver Disease: A Review on Pathophysiology, Clinical Consequences, and Treatment

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