Terlipressin for the treatment of acute variceal bleeding

Zhou, Xinmiao; Tripathi, Dhiraj; Song, Tingxue; Shao, Lichun; Han, Bing; Zhu, Jiang; Han, Dingfen; Liu, Fufang; Qi, Xingshun

doi:10.1097/md.0000000000013437

Cited by 58 publications

(33 citation statements)

References 41 publications

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“…Another meta-analysis that included three studies (n = 302 patients) that compared the efficacy of SSAs with Terlipressin found no statistically significant differences in the control of acute bleeding, the incidence of early recurrence and adverse events, transfusion requirements, or survival [166]. Some meta-analysis found that octreotide provided better bleeding control than vasopressin/terlipressin [167] and terlipressin [168] in patients with acute esophageal variceal bleeding.…”

Section: Acute Bleeding From the Gastrointestinal Tractmentioning

confidence: 99%

Somatostatin Analogs in Clinical Practice: A Review

Gomes-Porras

Cárdenas-Salas

Álvarez-Escolá

2020

IJMS

158

136

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Somatostatin analogs are an invaluable therapeutic option in the diagnosis and treatment of somatotropinomas, thyrotropinomas, and functioning and non-functioning gastroenteropancreatic neuroendocrine tumors. They should also be considered an effective and safe therapeutic alternative to corticotropinomas, gonadotropinomas, and prolactinomas resistant to dopamine agonists. Somatostatin analogs have also shown to be useful in the treatment of other endocrine diseases (congenital hyperinsulinism, Graves' orbitopathy, diabetic retinopathy, diabetic macular edema), non-endocrine tumors (breast, colon, prostate, lung, and hepatocellular), and digestive diseases (chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula).

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Section: Acute Bleeding From the Gastrointestinal Tractmentioning

confidence: 99%

Somatostatin Analogs in Clinical Practice: A Review

Gomes-Porras

Cárdenas-Salas

Álvarez-Escolá

2020

IJMS

158

136

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“…A recent meta-analysis reported no difference in rebleeding and mortality with either of these drugs. 27 All patients with suspected variceal bleed received carvedilol as secondary prophylaxis. Carvedilol has been shown to decrease mortality and reduce hepatic venous pressure gradient (HVPG) more than other non-selective beta-blockers.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding

Shalimar

Vaishnav

Elhence

et al. 2021

Journal of Clinical and Experimental Hepatology

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Background/Objective: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease-2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. Results: The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis-21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.

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“…Previous SRs [6,11,[35][36][37] have compared the efficacy of vasoactive agents with placebo, other vasoactive agents, or other non-pharmacological therapy. Few SRs have attempted to directly compare vasoactive agents used in AVB [10,38], and others have compared different therapies for AVB by network meta-analysis [39][40][41].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…There are two main groups of vasoactive agents for the treatment of AVB: vasopressin (V) and its synthetic analog terlipressin (T), and somatostatin (S) and its synthetic analog octreotide (O) [4][5][6][7]. Vasopressin is a potent systemic vasopressor with splanchnic effects, and T has the same properties but with a longer half-life and apparently fewer adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Huaringa-Marcelo

Huaman

Brañez-Condorena

et al. 2021

JGLD

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Background and Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I 2 =57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.

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Terlipressin for the treatment of acute variceal bleeding

Abstract: Supplemental Digital Content is available in the text

Cited by 58 publications

References 41 publications

Somatostatin Analogs in Clinical Practice: A Review

Somatostatin Analogs in Clinical Practice: A Review

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

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