COMPARISON OF THE EFFICACY OF CONTINUOUS TERLIPRESSIN INFUSION VERSUS INTERMITTENT BOLUS ADMINISTRATION IN PATIENTS WITH ACUTE VARICEAL BLEEDING DUE TO PORTAL HYPERTENSION

Background: Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with an estimated incidence of 134 per 100,000, roughly equating to one presentation every 6 min [1]. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK [2]. Patients with suspected variceal haemorrhage should be considered for prompt administration of variceal hemorrhage measures, terlipressin (or an alternative) and antibiotics.3 Terlipressin (triglycyl-lysine vasopressin), a long-acting synthetic analogue of arginine vasopressin, has been used in the treatment of variceal bleeding in patients with end-stage liver disease and paracentesis-induced circulatory dysfunction with tense ascites as well as hepatorenal syndrome. The purpose of this study is to compare the efficacy (in preventing re-bleeding) of continuous terlipressin infusion versus intermittent bolus administration in patients with acute variceal bleeding due to portal hypertension. As routinely intermittent terlipressin bolus administration in acute variceal bleeding is used in our setups, so my study will be a useful addition in this regard as we are evaluating the efficacy of continuous infusion as compared to intermittent bolus administration for preventing re-bleeding. Then on the basis of these results, some practical recommendations can be made in our routine practice guidelines to reducing re-bleeding in these particular patients.

Materials & Methods: The study was conducted at the Department of Gastroenterology, Holy Family Hospital, Rawalpindi from 28th June 2022 to 27th March 2023. It was a Randomized controlled trial. A total of 106 patients with acute variceal bleeding due to portal hypertension of age 18-70 years of either gender were included. Patients with HCC, renal failure (assessed on history and s/creatinine >1.5 mg/dl), hypersensitivity to terlipressin, acid peptic disease (assessed on history) and with upper GIT bleed with sources other than esophageal varices confirmed on endoscopy were excluded. 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. In both groups, all patients were undergone endoscopy and band ligation within 24 hours of admission. History of re-bleed was taken. Results: The mean age of patients in group A was 53.30 ± 10.45 years and in group B was 55.70 ± 10.19 years. Majority of the patients 87 (82.08%) were between 46 to 70 years of age. Out of these 106 patients, 57 (53.77%) were males and 49 (46.23%) were females with male to female ratio of 1.1:1. Efficacy in terms of no re-bleeding within one month was 47 (88.68%) in group A (continuous terlipressin infusion) and 33 (62.26%) in group B (intermittent terlipressin bolus administration) with p-value of 0.002. 

Conclusion: This study concluded that efficacy of continuous terlipressin infusion is better in patients with acute variceal bleeding due to portal hypertension as compared to intermittent bolus administration.

Keywords: upper gastrointestinal bleeding, continuous terlipressin infusion, portal hypertension.