Hemodynamic effects of terlipressin in patients with bleeding esophageal varices secondary to cirrhosis of liver.
OBJECTIVE
To study the hemodynamics of terlipressin in bleeding esophageal varices due to cirrhosis of the liver.


METHODS
A quasi-experimental study.


METHODS
Medical-ICU, Jinnah Postgraduate Medical Centre, Karachi from February to July 2005.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Badruddin
Aly Haider
AH
Department of Medical ICU, Jinnah Postgraduate Medical Centre, Karachi. alyhaider@cyber.net.pak
Rasool
Ghulam
G
Chaudhry
M Azhar
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011674:Pulse; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin