Condition
Variceal Bleeding
Variceal bleeding happens when swollen veins in the food pipe or stomach, enlarged by high pressure in the liver's blood supply, tear and bleed. The evidence is strongest for terlipressin: trials found that people with acute bleeding who received it were less likely to die than those given placebo, roughly a third lower relative risk. That result covers deaths from any cause during acute bleeding, and little other research on this condition has been reviewed here so far.
Sources: PMID 30508958; PMID 12492732
- Updated
- How we grade
- 37 studies cited
- Supplements studied
- 0
- Medicines and peptides
- 1
- Graded outcomes
- 2
No supplement studies yetWe haven’t found supplement studies for Variceal Bleeding. The medicines and peptides studied for it are listed below.
Prescription medicines and peptides studied, for context
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Bleeding Control (Variceal) 2018 meta-analysis (30 RCTs, 3344 patients): Terlipressin significantly improved bleeding control within 48h vs no vasoactive drug (OR 2.94, P=0.0008). Reduced need for emergency procedures (RR 0.72 vs placebo). | Improves (the measure goes up) | Large effect | 8 studies | |||
Studies that measured bleeding control (variceal)
| ||||||
| Mortality Reduction (Variceal Bleeding) Cochrane meta-analysis (7 RCTs, 443 patients): Terlipressin reduced all-cause mortality vs placebo (RR 0.66, 95% CI 0.49-0.88). 34% relative risk reduction. The only vasoactive agent proven to reduce mortality in acute variceal hemorrhage. | Improves (the measure goes down) | Large effect | 6 studies | |||
Studies that measured mortality reduction (variceal bleeding)
| ||||||
Key findings
- Bleeding Control (Variceal)Improves (the measure goes up)
- Mortality Reduction (Variceal Bleeding)Improves (the measure goes down)
Safety notes in the studies
- 34% relative risk reduction.
Studies cited
37 studies from PubMed
- Multisystem hemodynamic effects of terlipressin in cirrhosis: A scoping review.
- Terlipressin for the treatment of hepatorenal syndrome: a meta-analysis of randomized controlled trials.
- Terlipressin Administration Strategies in Hepatorenal Syndrome-Acute Kidney Injury: A Narrative Review of Continuous Infusion and Intermittent Bolus Approaches.
- Terlipressin use in HRS-AKI and respiratory failure.
- Safety and efficacy of continuous terlipressin infusion in HRS-AKI in a transplant population.
- Incidence and type of adverse events in patients with cirrhosis receiving terlipressin: A systematic review and meta-analysis.
- Comparative efficacy of terlipressin and norepinephrine for treatment of hepatorenal syndrome-acute kidney injury: A systematic review and meta-analysis.
- Early treatment with terlipressin in patients with hepatorenal syndrome yields improved clinical outcomes in North American studies
- Terlipressin and the Treatment of Hepatorenal Syndrome: How the CONFIRM Trial Moves the Story Forward
- Respiratory events with terlipressin and albumin in hepatorenal syndrome: A review and clinical guidance.
- Terlipressin use and respiratory failure in patients with hepatorenal syndrome type 1 and severe acute-on-chronic liver failure.
- Efficacy and Safety of Vasopressin and Terlipressin in Preterm Neonates: A Systematic Review.
- [Effect of terlipressin on prognosis of adult septic shock patients: a Meta-analysis].
- Role of Terlipressin in Cirrhotic Patients with Ascites and without Hepatorenal Syndrome: A Systematic Review of Current Evidence.
- Effectiveness of Terlipressin on Modulation of Portal Vein Pressure after Hepatic Resections in Non-Cirrhotic Patients. A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
- Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials
- Terlipressin or norepinephrine, or both in septic shock?
- Terlipressin in the treatment of hepatorenal syndrome: A systematic review and meta-analysis.
- Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT-0401 and REVERSE randomised clinical studies
- Terlipressin versus noradrenaline in the treatment of hepatorenal syndrome: systematic review with meta-analysis and full economic evaluation.
- Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
- Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: a meta-analysis.
- Vasopressin and terlipressin in neonates and children with refractory septic shock.
- Terlipressin for hepatorenal syndrome.
- Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis.
- Terlipressin in hepatorenal syndrome: Evidence for present indications.
- Terlipressin in hepatorenal syndrome.
- Terlipressin therapy for reversal of type 1 hepatorenal syndrome: a meta-analysis of randomized controlled trials.
- Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials.
- Terlipressin: a promising vasoactive agent in hemodynamic support of septic shock.
- A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome
- Pharmacology, clinical efficacy and safety of terlipressin in esophageal varices bleeding, septic shock and hepatorenal syndrome
- Meta-analysis: terlipressin therapy for the hepatorenal syndrome.
- Terlipressin for hepatorenal syndrome.
- Terlipressin: vasopressin analog and novel drug for septic shock.
- Terlipressin for acute esophageal variceal hemorrhage
- Systematic review: terlipressin in acute oesophageal variceal haemorrhage