The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites--a randomized multicentric study.
OBJECTIVE
Postparacentesis circulatory dysfunction is the most severe complication of ascites paracentesis. The aim of our study was to compare the standard treatment with the administration of a vasoconstrictor terlipressin.


METHODS
Forty-nine patients treated by paracentesis due to tense ascites were randomized for the treatment with albumin (8g/L of removed ascites) or terlipressin (1 mg every four hours for 48 hours). The blood pressure, heart rate, diuresis, electrocardiograph, standard biochemical and hematological parameters, sodium, potassium and nitrogen urinary excretion, aldosterone and renin activity in the blood plasma were monitored for a period of 72 hours.


RESULTS
In any parameter of hemodynamic changes, no statistically significant difference was demonstrated between randomized groups, in particular measurements as well as in the development in the course of the first three days after the intervention. The result suggests similar efficacy of the circulatory dysfunction prevention after the paracentesis in both treatment procedures. In both groups, on the first three days, there was a tendency to improve hemodynamics reflected by the renin-angiotensin-aldosteron system activity. In the terlipressin group, this tendency approached statistically significant levels.


CONCLUSIONS
The administration of terlipressin in a dose of 1 mg every fourth hour performed for a period of 48 hours was as effective as intravenous albumin in preventing hemodynamic changes in patients with tense ascites treated by paracentesis. The treatment was well tolerated.
Lata
Jan
J
Department of Internal Medicine and Gastroenterology, University Hospital Brno, Jihlavska 20 625 00 Brno, Czech Republic. jlata@fnbrno.cz
Marecek
Zdenek
Z
Fejfar
Tomas
T
Zdenek
Petr
P
Brůha
Radan
R
Safka
Vaclav
V
Hůlek
Petr
P
Hejda
Vaclav
V
Dolina
Jirí
J
Stehlík
Jirí
J
Tozzi
Igor
I
D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects; D012083:Renin / Q000097:blood; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000418:Albumins; D014662:Vasoconstrictor Agents; D000450:Aldosterone; D008236:Lypressin; D000077585:Terlipressin; D012083:Renin