Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study.

Abstract

BACKGROUND:

Therapeutic paracentesis in patients with cirrhosis induces arterial vasodilatation, causes a decrease in effective arterial blood volume and leads to circulatory dysfunction, which can be prevented by intravenous albumin. However, the use of albumin, being a blood product, is controversial. Recently, terlipressin, a vasoconstrictor, has been successfully used to combat this adverse effect of therapeutic paracentesis. Therefore, the aim of the present study was to investigate the preventive effect of terlipressin on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared with that of intravenous albumin.

METHODS:

Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or terlipressin in a randomized pilot study at a tertiary center. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 4-6 days after treatment.

RESULTS:

Effective arterial blood volumes as indicated by plasma renin activity before and 4-6 days after paracentesis did not differ in the two groups (19.15 +/- 12.1 to 20.33 +/- 12.8 ng/mL per h, P = 0.46 in the albumin group; and 20.11 +/- 10.6 to 21.08 +/- 10.52 ng/mL per h, P = 0.44 in the terlipressin group). Plasma aldosterone concentrations before and 4-6 days after paracentesis were also similar in both groups (1334.75 +/- 1058 to 1440.0 +/- 1161 pg/mL, P = 0.06 in the albumin group; and 1473.0 +/- 1168 to 1572.29 +/- 1182 pg/mL, P = 0.24 in the terlipressin group). Both terlipressin and albumin prevented paracentesis-induced renal impairment in these patients.

CONCLUSIONS:

Terlipressin may be as effective as intravenous albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis.

• Authors: Virendra Singh, Ramesh Kumar, Chander Kanwal Nain, Baljinder Singh, Arun K Sharma
• Journal: Journal of gastroenterology and hepatology (J Gastroenterol Hepatol) Vol. 21 Issue 1 Pt 2 Pg. 303-7 (Jan 2006) ISSN: 0815-9319 [Print] Australia
• PMID: 16460491 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Albumins
• Plasma Substitutes
• Vasoconstrictor Agents
• Aldosterone
• Lypressin
• Terlipressin
• Renin

Topics

• Albumins (therapeutic use)
• Aldosterone (blood)
• Ascites (etiology, therapy)
• Blood Volume
• Female
• Hemodynamics
• Humans
• Liver Cirrhosis (complications)
• Lypressin (analogs & derivatives, therapeutic use)
• Male
• Middle Aged
• Paracentesis (adverse effects)
• Plasma Substitutes (therapeutic use)
• Renin (blood)
• Terlipressin
• Vasoconstrictor Agents (therapeutic use)