Continuous vs bolus infusion of terlipressin: Which works best in acute variceal haemorrhage?

Administration of terlipressin as either continuous or bolus infusion results in similar length of hospital stay, packed cell volume, rebleeding, and mortality rates in patients with acute variceal haemorrhage, a recent study has shown.

Some 128 patients with acute variceal bleeding were randomly allocated to receive continuous (intervention arm) or bolus infusion (control arm) of terlipressin.

The investigators assessed in-hospital mortality, 6-week mortality, length of hospital stay, rebleeding and transfusion rates, and adverse events. They also examined haemodynamic outcomes, including stability of heart rate, systolic (SBP), diastolic, and mean artery blood pressures.

No case of in-hospital mortality was recorded in either arm (p=0.490). The mean length of hospital stay was 60.56 h in the intervention arm and 57.80 h in the control arm (p=0.569). Rebleeding occurred in two patients in each arm (p=0.569).

The rates of packed cell transfusion did not significantly differ between the intervention arm and the control arm (2.47 vs 2.17 units; p=0.256). Mortality at 6 weeks was seven and 12, respectively (p=0.220).

Bolus administration resulted in a greater reduction in heart rate at 4, 8, and post-20 h (p<0.05), while continuous infusion led to improvements in SBP at 16 and 24 h (p=0.02).

“Somewhat better improvement in SBP was observed in patients who received a continuous infusion of terlipressin without any impact on clinical outcomes,” the investigators said.