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Journal

Short Course Adjuvant Terlipressin in Acute Variceal Bleed: A Randomized Double Blind Dummy Controlled Trial

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Published:25th Mar 2020
Background & aims: Terlipressin is recommended for 3-5 days as adjuvant to Endoscopic Variceal Band Ligation (EVBL) in esophageal variceal bleed (EVB). We assessed if Terlipressin for shorter duration can be given in patients with EVB. Methods: All eligible EVB patients received 24 hours of open label Terlipressin at presentation. Randomization was done immediately after successful EVBL to receive active or Dummy Terlipressin for the next 48 hours. We excluded patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma and/or portal vein thrombosis, advanced cirrhosis (Child�s score12), and patients on ventilator. The primary outcome was failure to control EVB. The secondary outcomes were 30-day mortality; re-bleed and composite outcome of failure to control EVB. Results: A total of 130 eligible patients were randomized to receive Terlipressin for a total of 24 hours (short course or SC) or 72 hours (usual course or UC). Baseline patient characteristics were comparable; majority of patients were HCV infected and predominantly male. There was one failure to control EVB (1.5%) in UC and none in SC Terlipressin (p=0.50). The 30-day re-bleed rate was 1.5% and 3.1% patients in UC versus SC Terlipressin (p=0.50). The 30-day mortality was observed in 12 patients, 6 (9.2%) in each group (p=0.50). The 30-day failure to control bleed was observed in 14 patients; 7 in each group (p=0.494). Conclusions: A 24 hours course of Terlipressin is as effective as 72 hours when used as an adjunctive therapy to successful EVBL in patients with esophageal variceal bleeding.

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