Clinical Outcomes of Terlipressin Using Continuous Infusion Versus Bolus in Patients With Acute Variceal Hemorrhage–A Randomized Controlled Trial

Goals: To compare clinical outcomes of terlipressin as continuous versus bolus infusion for the management of acute variceal hemorrhage. Background: Terlipressin is commonly used in the management of acute variceal bleeding, but evidence on the optimal method of administration—continuous infusion versus intermittent bolus—is limited. Study: Patients presented with acute variceal bleeding were randomized into 2 arms: the intervention arm and the control arm received continuous and bolus infusion of terlipressin, respectively. Clinical endpoints included in-hospital mortality, 6-week mortality, the length of hospital stay, rebleeding and transfusion rates, and adverse events. Hemodynamic outcomes included were stability of heart rate, systolic, diastolic, and mean arterial blood pressures. Results: A total of 128 patients were analysed. In-hospital mortality was none in both arms ( P =0.490). Mean length of stay for the intervention arm was 60.56±30.87 hours and the control arm was 57.80±33.35 hours ( P =0.569). Rebleeding was reported in 2 patients in each arm ( P =0.569). Packed cell transfusion rates were, 2.47±1.59 versus 2.17±0.98 units in intervention and control arm, respectively ( P =0.256). The 6-week mortality was 7 in the intervention and 12 in the control arms ( P =0.220). Bolus administration led to a greater reduction in heart rate at 4, 8, and post-20 hours ( P <0.05). Systolic blood pressure improved at 16 and 24 hours in the intervention arm ( P =0.02). Conclusions: There was no difference in length of hospital stay, packed cell volume, rebleeding, and mortality between both modes of terlipressin administration. Somewhat better improvement in systolic blood pressure was observed in patients who received a continuous infusion of terlipressin without any impact on clinical outcomes.