Short course adjuvant terlipressin in acute variceal bleeding: A randomized double blind dummy controlled trial

Abstract

In patients with esophageal variceal bleeding, a 24-h course of terlipressin is as effective as a 72-h course when used as an adjunctive therapy to successful EVBL.

Optimizing General Management of Acute Variceal Bleeding in Cirrhosis

“…However, it is possible that a shorter administration of vasoactive drugs (48-72 hours) can achieve similar efficacy. A recent controlled study showed a similar efficacy using terlipressin for 24 hours or for 72 hours [35].…”

“…Given the high rate of permanent control of bleeding achieved with the current first-line treatment using vasoactive drugs, emergency ligation and antibiotic prophylaxis, only around 10 to 15 % of patients at risk of failure will require more invasive treatments with higher potential for harm, such as TIPS. However, around 50 % of patients with variceal bleeding had an HVPG ≥20 mmHg [6,15], and around 35 to 40 % are Child-Pugh class C or class B with active bleeding [33][34][35]. Furthermore, it has recently been suggested that the MELD score can better identify patients at high risk [65], while it is likely that the association of hemodynamic parameters, such as HVPG, with clinical parameters may improve the predictive ability.…”

Controlled trial of ligation plus vasoconstrictor versus proton pump inhibitor in the control of acute esophageal variceal bleeding

“…The low number of very early rebleeding and failures to control bleeding demonstrated the effectiveness of banding in both groups of patients. A recent study showed that 24‐h course of terlipressin was as effective as a 72‐h course when used as an adjunctive therapy to successful EVL . These results implied that once acute variceal bleeding could be effectively arrested by EVL, the additional value of vasoconstrictor becomes not so apparent.…”

Recent advances in the management of variceal bleeding

“…In the UK, we use terlipressin 2 mg qds for 24–72 hours or until satisfactory haemostasis has been achieved. In fact, once haemostasis has been achieved with endoscopic band ligation, 24 hours of terlipressin is as effective as 72 hours [88]. …”