title: Short course adjuvant terlipressin in acute variceal bleeding: a randomized double blind dummy controlled trial.
abstract: OBJECTIVE
  Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to patients with EVB.
  
  
  METHODS
  All eligible EVB patients received 24h of open label terlipressin at presentation. After successful EVBL, patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score ≥12), and patients on a ventilator. The primary outcome was failure to control EVB. The secondary outcomes were 30-day mortality; re-bleeding and composite outcome of failure to control EVB.
  
  
  RESULTS
  A total of 130 eligible patients were randomized to receive terlipressin for a total of 24 (short course or SC) or 72 h (usual course or UC). Baseline patient characteristics were comparable; the majority of patients were HCV-infected and male. There was one failure to control EVB (1.5%) in UC and none in SC terlipressin (p=0.50). The 30-day re-bleeding rate was 1.5% and 3.1% in UC, and SC terlipressin, respectively (p=0.50). The 30-day mortality was 12, 6 (9.2%) patients in each group (p=0.50). The 30-day failure to control bleeding was observed in 14 patients; seven in each group (p=0.494).
  
  
  CONCLUSIONS
  In patients with esophageal variceal bleeding, a 24-h course of terlipressin is as effective as a 72-h course when used as an adjunctive therapy to successful EVBL.
authors.affiliation: Section of Gastroenterology, Department of Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Azam
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salih
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.forename: Hasnain
authors.initials: H
authors.lastname: Shah
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008026:Ligation; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin