2. Academic Validation
  3. Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials

Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials

  • Medicine (Baltimore). 2018 Nov;97(48):e13437. doi: 10.1097/MD.0000000000013437.
Xinmiao Zhou 1 2 3,  Dhiraj Tripathi 4,  Tingxue Song 1 3,  Lichun Shao 3,  Bing Han 1 2,  Jia Zhu 1 5,  Dan Han 1,  Fufang Liu 1 2,  Xingshun Qi 1
Affiliations

Affiliations

  • 1 Meta-Analysis Interest Group & Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area.
  • 2 Postgraduate College, Jinzhou Medical University, Jinzhou.
  • 3 Department of Gastroenterology, No. 463 Hospital of Chinese PLA.
  • 4 Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • 5 Postgraduate College, Shenyang Pharmaceutical University, Shenyang, P.R. China.
PMID: 30508958 DOI: 10.1097/MD.0000000000013437
Abstract

Background and aim: Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis.

Methods: We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology.

Results: Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = -2.70, P = .02). Quality of evidence was very low to moderate.

Conclusion: Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.

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