Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients

doi:10.1016/S0140-6736(95)92708-5

The Lancet

Volume 346, Issue 8979, 30 September 1995, Pages 865-868

https://doi.org/10.1016/S0140-6736(95)92708-5 Get rights and content

Abstract

Summary

Upper gastrointestinal bleeding (GIB) is a major complication in cirrhotic patients. Endoscopy and oesophageal sclerosis are reference treatments and must be done as soon as possible. However, such treatment is not possible unless the patient is admitted to hospital.

In a prospective, randomised, double-blind trial, we compared the efficacy of terlipressin combined with glyceryl trinitrate (TER-GTN), administered as early as possible to 76 patients with cirrhosis who had active GIB (84 bleeding episodes). Infusion was done at the patient's home by the physician on the emergency team (a mobile intensive care unit) if the patient had GIB and a history and clinical signs of cirrhosis. Patients received either an intravenous injection (1 to 2 mg) of TER-GTN or a double-placebo injection, and then another injection at 4 and 8 h. Control of bleeding, rebleeding, and mortality rate at days 15 and 42 were evaluated. In most patients, endoscopy confirmed the rupture of oesophageal varices (75·7%). Bleeding control was significantly better in the TER-GTN group (n=41) than in the double-placebo group (n=43) (p=0·034). Mortality due to bleeding episodes was significantly lower in the TER-GTN group than in the double-placebo group at day 15 (p=0·035) and at day 42 (p=0·06). There were no serious side-effects.

Early administration of TER-GTN lowers the deleterious consequences of prolonged hypovolaemia on the hepatic function of these patients.

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Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients

Abstract

Gastroentrol Clin North Am

Gastroenterology

Curr Ther Res

J Hepatol

Lancet

J Hepatol

Morbidity and mortality of portal hypertension

Drugs

Transection of the oesophageal varices

Br J Surg

The management of bleeding due to portal hypertension. Part 1: the management of acute bleeding episodes

Q J Med