Continuous terlipressin infusion better than intermittent boluses for variceal bleeding
: Continuous intravenous infusion of terlipressin is more effective versus intermittent boluses of terlipressin for preventing treatment failure in patients with acute variceal bleeding (AVB), according to a new study at the Indira Gandhi Institute of Medical Sciences, Patna.
The study, published in the Indian Journal of Gastroenterology, is the first such study to compare continuous infusion of terlipressin with intermittent bolus in patients with AVB.
In this prospective, randomized controlled trial, assigned patients with AVB in portal hypertension; 43 patients received continuous intravenous infusion (Group A) and another 43 received intravenous boluses of terlipressin (Group B).
Group A received 1 mg intravenous bolus of terlipressin followed by a continuous infusion of 4 mg in 24 h. Group B received 2 mg intravenous bolus of terlipressin followed by 1 mg intravenous injection every 6 h.
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- Researchers noted treatment failure in 4.7% and 20.7% of patients in the continuous infusion and intermittent infusion groups, respectively.
- Within 6 weeks of treatment, the continuous vs intermittent infusion groups showed rebleeding in 11.6% vs 27.9% of patients.
- Deaths reported within 6 weeks were 4 and 8 in continuous and intermittent groups, respectively.
- Model for end-stage liver disease sodium (MELD-Na) score and continuous infusion of terlipressin showed a significant relationship with treatment failure on multivariate analysis.
Also Read: APWG Updated Guideline on non-variceal upper Gl bleeding
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