How To Reduce Gastroesophageal Varices Rebleeding During The Dose Reduction Of Terlipressin

Objective To explore the rebleeding factors during the dose reduction of the terlipressin, and to find ways to reduce the risk of rebleeding after the control of hemorrhage by collecting the clinical data related to the patients received terlipressin therapy after cirrhosis induced gastroesophageal varicosis hemorrhage.Methods The data of 54 patients received terlipressin therapy after hemorrhage for cirrhotic portal hypertension from October 2012 to October 2014 in Shanghai Ruijin Hospital were collected retrospectively. The patients were grouped into No Rebleeding Group(31 cases) and Rebleeding Group(23 cases) according to whether rebleeding happened during the reduction of terlipressin. SPSS analysis was used to assess the risk factors of rebleeding, as well as the correlation with treatment duration and reduction modes.Results As data was compared, there was significant difference(P <0.05) in portal vein flow velocity, splenic vein width, prothrombin time and primary bleeding rates between the two groups. A part of the patients in mild state was removed based on the risk factors. Further analysis found that for patients in more severe state, using the slowly reduction approach can lower the rebleeding rate(OR=0.75, 95% CI of 0.18-1.87, P=0.046).Conclusions In clinical work, for patients with acute cirrhosis induced esophagus varicosis rupture heamorrhage, the prothrombin time should be corrected before the reduction of terlipresin. B-mode ultrasonography may be a promising way to assess the rebleeding rate. More researches should be done to evaluate the predictive efficient of Portal vein flow velocity and splenic vein width. For most of the patients in severe state, the risk of rebleeding can be lowered if terlipressin was reduced slowly.