Terlipressin vs. Octreotide in Bleeding Esophageal Varices as an Adjuvant Therapy With Endoscopic Band Ligation: A Randomized Double-Blind Placebo-Controlled Trial

Abid, Shahab; Jafri, Wasim; Salehiniya, Hamid; Salih, Mohammad; Azam, Zahid; Mumtaz, Khalid; Shah, Hasnain Ali; Abbas, Zaigham

doi:10.1038/ajg.2008.147

Cited by 69 publications

(50 citation statements)

References 16 publications

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“…This could be explained by the nature of introducing a new system to the medical community where we would expect to see more familiarity with the change over time. [29][30][31] The rate of infection from SBP in the setting of variceal bleeding in our hospital was also equivalent to other studies. However, the order set was not used in 98 patients, and this indicates the potential size of the lost opportunity in the use of this standardized care for these patients.…”

Section: Discussionsupporting

confidence: 75%

The Utilization of Standardized Order Sets Using AASLD Guidelines for Patients With Suspected Cirrhosis and Acute Gastrointestinal Bleeding

Kijsirichareanchai

Ngamruengphong

Rakvit

et al. 2013

Quality Management in Health Care

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To improve the adherence to AASLD (American Association for the Study of Liver Diseases) guidelines for variceal bleeding, we developed and implemented standardized order sets for gastrointestinal bleeding in our hospital on October 1, 2009. We performed medical record reviews of hospitalized patients with gastrointestinal bleeding with suspected cirrhosis from October 2009 to October 2010 to determine the use of octreotide, prophylactic antibiotics, and endoscopy. We reviewed 300 Medical records and identified 26 patients with suspected cirrhosis and gastrointestinal bleeding who had adequate information to determine whether or not the order set was used. Antibiotic was used in 76% of patients, octreotide was used in 76% of patients, and upper endoscopy was completed in 94% of patients within 24 hours. The use of antibiotics was higher than that used in historical controls in our hospital. Implementation of standardized order sets appears to have improved adherence to standard recommendations. However, larger studies with longer follow-ups are needed to evaluate this effect on clinical outcomes and cost of care.

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Section: Discussionsupporting

confidence: 75%

The Utilization of Standardized Order Sets Using AASLD Guidelines for Patients With Suspected Cirrhosis and Acute Gastrointestinal Bleeding

Kijsirichareanchai

Ngamruengphong

Rakvit

et al. 2013

Quality Management in Health Care

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“…A second double‐blind RCT explored whether there were differences in clinical outcomes between terlipressin and ocreotide therapy in patients presenting with variceal bleeding . In this study, 324 patients were randomized to either terlipressin or octreotide in addition to standard endoscopic therapy.…”

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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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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“…The initial management of these patients should follow the same guidelines related to management of esophageal and gastric varices, including use of vasoactive substances such as octreotide or terlipressin, 10,11 as well as antibiotic prophylaxis. 12 Resuscitation efforts should be modest in an attempt to avoid elevation of portal pressures 13 and should be aimed at maintaining a hemoglobin level between 7-8 g/dl.…”

Section: General Considerations In Variceal Managementmentioning

confidence: 99%