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Continuous terlipressin infusion better than intermittent boluses for variceal bleeding

Continuous terlipressin infusion better than intermittent boluses for variceal bleeding

Patna, India: 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, Sanjeev Kumar Jha, Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India, and colleagues 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.

Also Read: Recent advances in management and treatment of variceal bleeding

Key Findings:
  • 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

According to the authors, the possible mechanism could be related to altered hemodynamic effects due to different infusion methods.
“Both continuous and intermittent infusion of terlipressin cause a rapid reduction in portal venous pressure at 1 hour but after that portal venous pressure remains stable in the continuous group while fluctuating in the intermittent group. The intermittent infusion cannot ensure that the positive effect of terlipressin on splanchnic hemodynamics maintained over 24 hours, which is guaranteed with the continuous intravenous administration of the drug,” write the authors.
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Source: With inputs from Indian Journal of Gastroenterology 

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