Variceal Rebleeding Rate and Infections Clinical Trial
Official title:
A Prospective, Randomized Controlled Trial of 2- Day vs. 5- Day Terlipressin and Ceftriaxone in the Prevention of Very Early Rebleeding in Patients With Acute Gastroesophageal Variceal Hemorrhage
The use of prophylactic antibiotics in cirrhotics with gastrointestinal bleeding has been a
routine clinical practice . It is still unknown whether use of short term vasoconstrictors
and antibiotics could have superior acute hemostatic rate.
Thus, the investigators conducted a trial to compare the effectiveness between participants
receiving terlipressin and ceftriaxone 5 days and terlipressin and ceftriaxone 2 days after
endoscopic therapy in cirrhotic patients presenting with acute gastro-esophageal variceal
hemorrhage..
Acute gastro-esophageal variceal hemorrhage is a dreadful complication of portal
hypertension. Meta-analysis showed that the combination of vasoconstrictor and endoscopic
therapy is superior to endoscopic therapy or vasoconstrictor alone in the control of acute
esophageal variceal hemorrhage. Bacterial infections are frequently encountered in cirrhotic
patients presenting with acute upper gastrointestinal bleeding. The association of bacterial
infections to variceal bleeding may increase the occurrence of variceal rebleeding and
mortality. A study has shown that antibiotic prophylaxis in patients with acute esophageal
variceal hemorrhage may reduce infection as well as prevent rebleeding. Currently, most
guidelines recommend that vasoactive drugs should be continued for 3 to 5 days after
endoscopic therapy and antibiotics should be instituted for up to 7 days to manage patients
with acute esophageal variceal hemorrhage . On the other hand, some studies in recent years
implied that short term vasoconstrictors or antibiotics could achieve similar low variceal
rebleeding rates. The use of prophylactic antibiotics in cirrhotics with gastrointestinal
bleeding for only one single dose or 3 days appeared to be feasible. It is still unknown
whether use of short term both vasoconstrictors and antibiotics could have similar acute
hemostatic rate.
Thus, the investigators conducted a trial to compare the effectiveness between participants
receiving terlipressin and ceftriaxone 5 days and terlipressin and ceftriaxone 2 days after
endoscopic therapy in cirrhotic patients presenting with acute gastroesophageal variceal
hemorrhage..
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