Terlipressin plus transdermal nitroglycerin vs. octreotide in the control of acute bleeding from esophageal varices: A multicenter randomized trial

Abstract

We undertook a multicenter randomized trial to compare the efficacy of terlipressin combined with transdermal nitroglycerin and that of octreotide in the emergency control of acute variceal hemorrhage in cirrhosis. Over 16 mo, 87 patients with endoscopically proved active bleeding from esophageal or cardiac varices were enrolled in five centers in France and randomly assigned to receive intravenous terlipressin (2 mg and then 1 mg/4 hr over 24 hr) and transdermal nitroglycerin (10 mg/12 hr over 24 hr) (group 1) or octreotide (continuous intravenous infusion of 25 micrograms/hr over 12 hr and then 100 micrograms at hr 12 and hr 18 subcutaneously) (group 2). Initial control of bleeding was assessed at the end of 12 hr of treatment on the basis of stability of blood pressure and hematocrit level with no further transfusion requirements. At 12 hr, bleeding was controlled in 59% (24 of 41) in group 1 and 78% (36/46) of group 2 patients (Fisher's exact test, p = 0.064). Mean transfusion requirements over this 12-hr period were significantly greater in group 1 (three blood units; range = 0 to 13) than in group 2 (one blood unit; range = 0 to 5) (p = 0.002). After the first 12 hr, 20% of patients (5 of 24) had repeat bleeding in group 1 compared with 27% (10 of 36) in group 2. During the first 48-hr period, five patients (12%) died in group 1, compared with 3 (6%) in group 2. Few side effects were noted in either group. However, in group 1 two patients experienced severe bradycardia; it resulted in death in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic effects of the somatostatin analog lanreotide in humans: Placebo-controlled, cross-over dose-ranging echo-doppler study

“…[1][2][3][4] In patients with cirrhosis and portal hypertension, it reduces splanchnic and azygos blood flow, 5,6 whereas the action with regard to portal pressure is modest. [5][6][7] Conversely, the effect(s) of natural somatostatin and its analog, octreotide, upon renal hemodynamics and function are unclear and have been a reason for debate.…”

Role of Vasoactive Drugs in the Treatment of Bleeding Oesophageal Varices

“…Octreotide was found to be comparable to balloon tamponade in one study (n = 40 patients) [57], to vasopressin in one (n = 87 patients) [58] and to terlipressin plus nitoglycerin in another (n = 48 patients; table 5) [59]. However, the sample sizes were small and the end-points not very clear, indicating that these results should be interpreted with caution.…”

Somatostatin or Octreotide in Acute Variceal Bleeding

“…Four recent trials compared somatosta-therapeutic compound, has a half-life of 2-3 min. Inhibition by somatostatin of the secretion of a number of tin or octreotide to terlipressin alone [4][5][6] or associated with nitroglycerin [7]. All four concluded that terlipressin hormones thought to play a role in the maintenance of portal hypertension (including glucagon and VIP) iniwas comparable to somatostatin or octreotide for the control of bleeding.…”

“…Its half-life [7], although it did not demonstrate a statistically significant difference in the incidence of side effects, reported is longer than that of somatostatin, and may be as long as 4 h in patients with cirrhosis [9]. While somatostatin severe bradycardia due to terlipressin in 2 patients, which was responsible for death in 1.…”