Badruddin Aly Haider, Rasool Ghulam, Chaudhry M Azhar
Department of Medical ICU, Jinnah Postgraduate Medical Centre, Karachi.
J Coll Physicians Surg Pak. 2006 Dec;16(12):755-9.
To study the hemodynamics of terlipressin in bleeding esophageal varices due to cirrhosis of the liver.
A quasi-experimental study.
Medical-ICU, Jinnah Postgraduate Medical Centre, Karachi from February to July 2005.
Seventy-eight consecutive patients with bleeding esophageal varices were evaluated. The diagnosis of cirrhosis was based on history, physical examination, laboratory data and abdominal ultrasound. Blood-pressure and pulse rate were monitored. Injection terlipressin 2 mg intravenous bolus was given followed by 2 mg i/v 6 hourly. Intravenous plasma expanders, whole blood, fresh frozen plasma and platelet concentrates were transfused as needed. Upper gastrointestinal endoscopy was performed for evaluation and grading of varices, detection of portal gastropathy, and banding. Descriptive and inferential statistics were applied as applicable.
Seventy patients of either gender, aged 18 - 95 years were included in the study. Systolic blood-pressure(SP) increased by 7.77 mmHg (mean SP: 108.1 mmHg, SD + 9.84, 95% CI: 105.77 - 110.43 mmHg; p-value: 0.0002); diastolic blood-pressure(DP) by 21.57 mmHg (mean DP: 79.71 mmHg, SD + 7.35, 95% CI: 77.97 - 81.45 mmHg; p-value: 0.001) and mean arterial pressure by 9.42 mmHg(mean MAP: 89.12 mmHg, SD + 6.98, 95% CI: 87.45 - 90.78 mmHg; p-value: 0.0007) within 24 hours of initiating terlipressin in majority of patients. The pulse rate decreased in 34 (48.5%) patients by 6-24 beats/min in 30 min, and by 2-12 beats/min in 24 hours; and increased in 30 (42.85)% patients by 10-15 beats/min at 30 min and by 2-8 beats/min at 24 hours.
Terlipressin had an overall benefit in significant number of patients with bleeding esophageal varices in this series and only a few adverse effects when given at recommended doses.
