EARLY ADMINISTRATION OF TERLIPRESSIN PLUS GLYCERYL TRINITRATE TO CONTROL ACTIVE UPPER GASTROINTESTINAL-BLEEDING IN CIRRHOTIC-PATIENTS

Upper gastrointestinal bleeding (GIB) is major complication in cirrhot ic patients. Endoscopy and oesophageal sclerosis are reference treatme nts and must be done as soon as possible. However, such treatment is n ot possible unless the patient is admitted to hospital. In a prospecti ve, randomised, double-blind trial, we compared the efficacy of terlip ressin combined with glyceryl trinitrate (TER-GTN), administered as ea rly as possible to 76 patients with cirrhosis who had active GIB (84 b leeding episodes). Infusion was done at the patient's home by the phys ician on the emergency team (a mobile intensive care unit) if the pati ent had GIB and a history and clinical signs of cirrhosis. Patients re ceived either an intravenous injection (1 to 2 mg) of TER-GTN or a dou ble placebo injection, and then another injection at 4 and 8 h. Contro l of bleeding, rebleeding, and mortality rate at days 15 and 42 were e valuated. In most patients, endoscopy confirmed the rupture of oesopha geal varices (75.7%), Bleeding control was significantly better in the TER-GTN group (n=41) than in the double-placebo group (n=43) (p=0.034 ). Mortality due to bleeding episodes was significantly lower in the T ER-GTN group than in the double-placebo group at day 15 (p=0.035) and at day 42 (p=0.06). There were no serious side-effects. Early administ ration of TER-GTN lowers the deleterious consequences of prolonged hyp ovolaemia on the hepatic function of these patients.