Early control of upper gastrointestinal bleeding in cirrhosis

Canadian Medical Association Journal 1996; 154: 1533-1534

Source: Levacher S, Letoumelin P, Pateron D et al: Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet 1995; 346: 865-868

Researchers in France investigated the efficacy of the vasopressin analogue terlipressin (1 to 2 mg intravenously at 0, 4 and 8 hours) in combination with glyceryl trinitrate (transdermal patch, 10 mg over 24 hours to reduce systemic effects of terlipressin) in a randomized placebo-controlled trial involving 76 patients with cirrhosis who presented with active upper gastrointestinal bleeding. At 12 hours bleeding control was significantly better in the treatment group than in the placebo group. The rates of death at 15 and 42 days were significantly reduced in the treatment group. The terlipressin-glyceryl trinitrate treatment was well tolerated. The authors conclude that early administration of terlipressin-glyceryl trinitrate to control gastrointestinal bleeding can minimize the adverse effects of prolonged hypovolemia and improve the diagnostic and therapeutic efficacy of endoscopy and sclerotherapy in eligible patients.

CMAJ May 15, 1996 (vol 154, no 10)