Bromocriptine – unique formulation of a dopamine agonist for the treatment of type 2 diabetes.

Expert Opin Pharmacother. 2009 Dec 23;

Authors: Scranton R, Cincotta A

Importance to the field: There is a large unmet need for new therapies to treat type 2 diabetes (T2DM) which reduce fasting and postprandial glucose without increasing insulin levels and which are not associated with weight gain or hypoglycemia. The quick-release formulation of bromocriptine (bromocriptine-QR; Cycloset) represents such a therapy. Areas covered in the review: Bromocriptine-QR’s proposed mechanism of action, unique formulation and clinical efficacy and safety will be discussed. A Medline search was conducted using the terms: bromocriptine quick-release, circadian rhythms, treatment type 2 diabetes, insulin resistance, beta-cell dysfunction (years 1985 – 2009). What the reader will gain: The reader will gain an understanding of the importance of the brain as a target for the treatment of type 2 diabetes. In addition the safety, efficacy and indication for use of a first-in-class dopamine agonist as a treatment option for type 2 diabetes are discussed. Take home message: Bromocriptine-QR is indicated to be used alone or in conjunction with all available treatments for type 2 diabetes. Although the mechanism of action is not fully understood, bromocriptine-QR’s action points to a central target in the brain (hypothalamus) which may explain the observed peripheral improvements in metabolic parameters.

PMID: 20030567 [PubMed - as supplied by publisher]

[Read more →]

Differences in pharmacology and their translation into differences in clinical efficacy – a comparison of the renin angiotensin blocking agents irbesartan and losartan.

Expert Opin Pharmacother. 2009 Dec 23;

Authors: Bramlage P, Schindler C

Importance of the field: Guidelines recommend five antihypertensive drug classes, but which particular drug to choose is up to the treating physician. We aimed at an in-depth comparison of two frequently used angiotensin receptor blockers to provide evidence for this decision. Areas covered in this review: Pharmacology of irbesartan and losartan, their blood-pressure-lowering efficacy, their tolerability/safety, end-organ protective effects and economic evaluation. What the reader will gain: Both drugs differ in their oral bioavailability, potential for food interactions, degree of metabolism, dosing interval, time to peak, volume of distribution and terminal half-life. Irbesartan provides a greater and longer-lasting antihypertensive effect and was determined to be cost effective over losartan in Denmark and Sweden. Irbesartan was more effective in preventing deterioration of kidney function in patients with diabetic nephropathy, being cost effective from a German perspective. There is only one end point trial for either drug in patients with left ventricular hypertrophy, heart failure and atrial fibrillation, but no direct comparison. Take home message: There is an incremental clinical benefit of irbesartan over losartan in the treatment of hypertension and diabetic nephropathy which can be substantiated by corresponding preclinical study evidence. This has translated into an economic benefit in a number of country-specific evaluations.

PMID: 20030566 [PubMed - as supplied by publisher]

[Read more →]

An unseen danger: Frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance.

Crit Care Med. 2010 Jan;38(1):346-347

Authors: Blaivas M

PMID: 20023507 [PubMed - as supplied by publisher]

[Read more →]

What is the appropriate approach to prevention of thromboembolism in heart failure?

Thromb Haemost. 2009 Dec 18;

Authors: Freudenberger RS, Schumaecker M, Homma S

Many studies suggest a higher incidence of thromboembolic syndromes such as stroke, peripheral arterial thrombosis and pulmonary embolism in patients with heart failure (HF), particularly those with left ventricular systolic dysfunction. As a result, some clinicians have chosen to treat patients with HF with anticoagulants as primary prevention against thromboembolic events. However, this practice is not well-supported by scientific data. Retrospective analyses of large HF trials have yielded contradictory results and randomised trials designed to specifically address this question have been under-populated and under-powered. As a result, there is no general consensus among professional societies in either recommending or advising against anticoagulants in HF. We hope that ongoing clinical trials, WARCEF in particular, will yield results that will guide clinicians in deciding for or against routine use of anticoagulants in HF.

PMID: 20024492 [PubMed - as supplied by publisher]

[Read more →]

Translumbar central venous catheters for long-term haemodialysis.

Nephrol Dial Transplant. 2009 Dec 18;

Authors: Power A, Singh S, Ashby D, Hamady M, Moser S, Gedroyc W, Taube D, Duncan N, Cairns T

BACKGROUND: Vascular access for haemodialysis is achieved by tunnelled central venous catheter (CVC) in at least 23% of prevalent patients in the UK, Canada and the USA. Use of CVCs is associated with an increased incidence of venous stenosis that can progressively limit future vascular access routes. Lack of conventional venous access routes mandates the use of alternative strategies such as the translumbar approach. METHODS: We retrospectively analysed patients at our centre requiring translumbar inferior vena caval CVCs (TesioCath) for haemodialysis in the period 1999-2008. Written and electronic records capturing dialysis adequacy and complications, hospital admissions and laboratory data were examined. RESULTS: Thirty-nine pairs of translumbar CVCs were inserted in 26 patients with 15 864 catheter days follow-up, mean patient age 61.9 +/- 12.1 years, 31% diabetic, 15% with ischaemic heart disease. All insertions were successful. Insertion of one CVC was associated with a self-limiting retroperitoneal haematoma. No patients died of a catheter-related cause or through lack of vascular access. Cumulative assisted primary catheter site patency was 81% at 6 months and 73% at 1 year (median 18.5 months). Good dialysis adequacy was achieved throughout (mean single-pool Kt/V 1.5 +/- 0.4). The incidence of access-related infection was 2.84/1000 catheter days (exit site infection rate 2.02/1000 catheter days; catheter-related bacteraemia rate 0.82/1000 catheter days). Catheter dysfunction (need for thrombolytic infusion or catheter change) led to 0.88 admissions per 1000 catheter days. CONCLUSION: Translumbar inferior vena caval CVCs can offer relatively safe and effective long-term haemodialysis access in patients with no other options.

PMID: 20023114 [PubMed - as supplied by publisher]

[Read more →]

Clinical Management of Pandemic (H1N1) Infection.

Chest. 2009 Dec 18;

Authors: Hui DS, Lee N, Chan PK

Antiviral therapy and vaccination are important strategies for controlling pandemic (H1N1) 2009 influenza but efficacy depends on the timing of administration and is often limited by shortage of supply. Patients with dyspnea, tachypnea, evidence of hypoxemia and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with acute respiratory distress syndrome. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in SARS and H3N2 infection. Low dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyper-immune globulin may be explored as rescue therapy. More data are needed to explore the potential role of intravenous gammaglobulin and other drugs with immuno-modulating properties such as statins, gemfibrozil, and N-acetyl-cysteine. Healthcare workers must apply strict standard and droplet precautions when dealing with suspected and confirmed cases, and upgrade to airborne precautions when performing aerosol-generating procedures. Non-pharmacological measures such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.

PMID: 20022969 [PubMed - as supplied by publisher]

[Read more →]

Increased risk of Myocardial Infarction and Stroke following Exacerbation of Chronic Obstructive Pulmonary Disease.

Chest. 2009 Dec 18;

Authors: Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA

OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) are at risk of cardiovascular events. This has been attributed to increased systemic inflammation. The course of COPD is punctuated by exacerbations, which further increase systemic inflammation, but the risk of vascular events in the post-exacerbation period has never been defined. DESIGN: We analysed data from 25,857 COPD patients entered in The Health Improvement Network (THIN) database over a two year period. Exacerbations were defined using a health care utilization definition of prescription of oral corticosteroids >20mg/day and/or selected oral antibiotics. The risk of myocardial infarction (MI) and stroke in the post-exacerbation period was calculated relative to the patient's baseline risk using the self-controlled case series approach. RESULTS: We identified 524 MI in 426 patients and 633 ischaemic strokes in 482 patients. The incidence rates of MI and stroke were 1.1 and 1.4 per 100 patient years respectively. There was a 2.27 fold (95% CI 1.1-4.7; P=0.03) increased risk of MI 1-5 days after exacerbation (defined by prescription of both steroids and antibiotics). This relative risk diminished progressively over time and was not significantly different from the baseline MI risk at any other post-exacerbation time interval. One in 2,513 exacerbations was associated with MI within 1-5 days. There was a 1.26 fold (95% CI 1.0-1.6; P=0.05) increased risk of stroke 1-49 days after exacerbation. CONCLUSION: The results suggest that exacerbations of COPD increase the risk of myocardial infarction and stroke. This may have implications for therapy in both stable and exacerbated COPD.

PMID: 20022970 [PubMed - as supplied by publisher]

[Read more →]

The TRITON versus PLATO trials: Differences beyond platelet inhibition.

Thromb Haemost. 2009 Dec 18;

Authors: Serebruany VL

Clopidogrel monopoly as an exclusive oral antiplatelet agent used in combination with aspirin or as a monotherapy for treatment or/and prevention of occlusive thrombotic vascular events has been recently challenged. Based on the indirect comparison of TRITON and PLATO trial data, ticagrelor is clearly superior to prasugrel in a population of patients with acute coronary syndrome (ACS) because of absolute mortality reduction, realistic second myocardial infarction (MI) prevention, growing over time vascular outcome benefit, fewer haemorrhagic fatalities, potentially less coronary artery bypass graft (CABG)- related bleeding events, and lack of cancer risks. Despite an unfavourable immediate safety profile, ticagrelor has a lot of room to compensate for agitation, dyspnea, and ventricular pauses, if used in appropriate patients. It will be naïve and wrong to assume that ticagrelor will completely substitute clopidogrel, especially considering higher discontinuation rates after ticagrelor, generic competition, and other health economics issues. However, unless the regulatory authorities discover some unexpected serious flaws with PLATO, the ticagrelor will substantially change the present landscape of oral antiplatelet therapy, especially in high-risk patients, diabetics, and those with repeated vascular events including stent thrombosis. In contrast, a too exclusive trial design, a lack of persistent vascular benefit despite issues with event adjudication, growing-over-time bleeding complications, an issue with cancer, and finally an increase in mortality risk will likely prevent a broad prasugrel implementation, unless more reassuring evidence becomes available.

PMID: 20024505 [PubMed - as supplied by publisher]

[Read more →]

Health Care-Associated Clostridium difficile Infection in Canada: Patient Age and Infecting Strain Type Are Highly Predictive of Severe Outcome and Mortality.

Clin Infect Dis. 2009 Dec 21;

Authors: Miller M, Gravel D, Mulvey M, Taylor G, Boyd D, Simor A, Gardam M, Mc Geer A, Hutchinson J, Moore D, Kelly S

Background. C. difficile infection (CDI) has become an important and frequent nosocomial infection, often resulting in severe morbidity or death. Severe CDI is more frequently seen among individuals infected with the emerging NAP1/027/BI (NAP1) strain and in the elderly population, but the relative importance of these 2 factors remains unclear. We used a large Canadian database of patients with CDI to explore the interaction between these 2 variables. Methods. The Canada-wide CDI study, performed in 2005 by the Canadian Nosocomial Infection Surveillance Program (CNISP), was used to analyze the role of infecting strain type and patient age on the severity of CDI. A severe outcome was defined as CDI requiring intensive care unit care, colectomy, or causing death (directly or indirectly) within 30 days after diagnosis. Results. A total of 1008 patients in the CNISP database had both complete clinical data and infecting strain analysis documented. A total of 311 patients (31%) were infected with the NAP1 strain, 83 (28%) were infected with the NAP2/J strain, and the rest were infected with various other types. The proportion of NAP1 infections correlated with the incidence and the severity of CDI when analyzed by province. Thirty-nine (12.5%) of the infections due to the NAP1 strain resulted in a severe outcome, compared with only 41 (5.9%) of infections due to the other types ([Formula: see text]). The patient's age was strongly associated with a severe outcome, and patients 60-90 years of age were approximately twice as likely to experience a severe outcome if the infection was due to NAP1, compared with infections due to other types. Conclusions. Our study confirms the strong age association with infection due to the NAP1 strain and severe CDI. In addition, patients 60-90 years of age infected with NAP1 are approximately twice as likely to die or to experience a severe CDI-related outcome, compared with those with non-NAP1 infections. Patients >90 years of age experience high rates of severe CDI, regardless of strain type.

PMID: 20025526 [PubMed - as supplied by publisher]

[Read more →]

Safety and Efficacy of Intravenous Tigecycline in Subjects with Secondary Bacteremia: Pooled Results from 8 Phase III Clinical Trials.

Clin Infect Dis. 2009 Dec 21;

Authors: Gardiner D, Dukart G, Cooper A, Babinchak T

Background. Tigecycline is effective in the treatment of complicated skin/skin-structure infection (cSSSI), complicated intraabdominal infection (cIAI), and community-acquired bacterial pneumonia (CAP), but its efficacy in subjects with secondary bacteremia is unknown. Methods. Pooled data from subjects enrolled for treatment of cSSSI, cIAI, or CAP presenting with bacteremia from 7 double-blind and 1 open-label trial of tigecycline compared with vancomycin-aztreonam, imipenem-cilastatin, levofloxacin, vancomycin, or linezolid were analyzed. The primary efficacy end point was the clinical cure rate at the test-of-cure assessment. Results. A total of 170 subjects were identified (91 tigecycline recipients and 79 recipients of the comparator agent). Clinical cure rates were 81.3% and 78.5% for tigecycline and the comparator, respectively ([Formula: see text]). Analysis by sex, age, creatinine clearance, infection site, Acute Physiology and Chronic Health Evaluation score, and Fine score demonstrated no significant between-group differences. Clinical cure rates for the most commonly represented pathogens (Staphylococcus aureus, Streptococcus pneumoniae, and gram-negative species) were also not significantly different between treatment groups. No decrease in the rate of cure was found in organisms with increasing tigecycline minimum inhibitory concentrations. Nine subjects treated with tigecycline and 1 subject treated with comparator were found to have persistent bacteremia. No clinically significant differences in safety parameters were identified. Conclusions. Tigecycline was generally safe and well tolerated in the treatment of secondary bacteremia associated with cSSSI, cIAI, and CAP; cure rates were similar to comparative standard therapies.

PMID: 20025527 [PubMed - as supplied by publisher]

[Read more →]

NP hospitalists. A new niche for NPs.

Adv Nurse Pract. 2009 Feb;17(2):43-4, 46

Authors: Ford J

PMID: 19999424 [PubMed - in process]

[Read more →]

Safety and immunogenicity of 2009 pandemic influenza A H1N1 vaccines in China: a multicentre, double-blind, randomised, placebo-controlled trial.

Lancet. 2009 Dec 15;

Authors: Liang XF, Wang HQ, Wang JZ, Fang HH, Wu J, Zhu FC, Li RC, Xia SL, Zhao YL, Li FJ, Yan SH, Yin WD, An K, Feng DJ, Cui XL, Qi FC, Ju CJ, Zhang YH, Guo ZJ, Chen PY, Chen Z, Yan KM, Wang Y

BACKGROUND: The current influenza pandemic calls for a safe and effective vaccine. We assessed the safety and immunogenicity of eight formulations of 2009 pandemic influenza A H1N1 vaccine produced by ten Chinese manufacturers. METHODS: In this multicentre, double-blind, randomised trial, 12 691 people aged 3 years or older were recruited in ten centres in China. In each centre, participants were stratified by age and randomly assigned by a random number table to receive one of several vaccine formulations or placebo. The study assessed eight formulations: split-virion formulation containing 7.5 mug, 15 mug, or 30 mug haemagglutinin per dose, with or without aluminium hydroxide adjuvant, and whole-virion formulation containing 5 mug or 10 mug haemagglutinin per dose, with adjuvant. All formulations were produced from the reassortant strain X-179A (A/California/07/2009-A/PR/8/34). We analysed the safety (adverse events), immunogenicity (geometric mean titre [GMT] of haemagglutination inhibition antibody), and seroprotection (GMT >/=1:40) of the formulations. Analysis was by per protocol. Two sites registered their trial with ClinicalTrials.gov, numbers NCT00956111 and NCT00975572. The other eight studies were registered with the State Food and Drug Administration of China. FINDINGS: 12 691 participants received the first dose on day 0, and 12 348 participants received the second dose on day 21. The seroprotection rate 21 days after the first dose of vaccine ranged from 69.5% (95% CI 65.9-72.8) for the 7.5 mug adjuvant split-virion formulation to 92.8% (91.9-93.6) for the 30 mug non-adjuvant split-virion formulation. The seroprotection rate was 86.5% (796 of 920; 84.1-88.7) in recipients of one dose of the 7.5 mug non-adjuvant split-virion vaccine compared with 9.8% (140 of 1432; 8.3-11.4) in recipients of placebo (p<0.0001). One dose of the 7.5 mug non-adjuvant split-virion vaccine induced seroprotection in 178 of 232 children (aged 3 years to <12 years; 76.7%, 70.7-82.0), 211 of 218 adolescents (12 years to <18 years; 96.8%, 93.5-98.7), 289 of 323 adults (18-60 years; 89.5%, 85.6-92.6), and 118 of 147 adults older than 60 years (80.3%, 72.9-86.4), meeting the European Union's licensure criteria for seroprotection in all age-groups. In children, a second dose of the 7.5 mug formulation increased the seroprotection rate to 97.7% (215 of 220, 94.8-99.3). Adverse reactions were mostly mild or moderate, and self-limited. Severe adverse effects occurred in 69 (0.6%, 0.5-0.8) recipients of vaccine compared with one recipient (0.1%, 0-0.2) of placebo. The most common severe adverse reaction was fever, which occurred in 25 (0.22%; 0.14-0.33) recipients of vaccine after the first dose and four (0.04%; 0.01-0.09) recipients of vaccine after the second dose compared with no recipients of placebo after either dose. INTERPRETATION: One dose of non-adjuvant split-virion vaccine containing 7.5 mug haemagglutinin could be promoted as the formulation of choice against 2009 pandemic influenza A H1N1 for people aged 12 years or older. In children (aged <12 years), two 7.5 mug doses might be needed. FUNDING: Sinovac Biotech, Hualan Biological Bacterin, China National Biotec Group, Beijing Tiantan Biological Products, Changchun Institute of Biological Products, Changchun Changsheng Life Sciences, Jiangsu Yanshen Biological Technology Stock, Zhejiang Tianyuan Bio-Pharmaceutical, Lanzhou Institute of Biological Products, Shanghai Institute of Biological Products, and Dalian Aleph Biomedical.

PMID: 20018364 [PubMed - as supplied by publisher]

[Read more →]

Immune response after a single vaccination against 2009 influenza A H1N1 in USA: a preliminary report of two randomised controlled phase 2 trials.

Lancet. 2009 Dec 15;

Authors: Plennevaux E, Sheldon E, Blatter M, Reeves-Hoché MK, Denis M

BACKGROUND: Data are needed from large clinical trials of paediatric, adult, and elderly people to find the appropriate antigen dose and vaccination schedule for the 2009 pandemic influenza A H1N1. We therefore report preliminary safety and immunogenicity results after one injection of a licensed monovalent pandemic H1N1 vaccine in the USA. METHODS: We randomly assigned healthy children (aged 6-35 months and 3-9 years) and adults (18-64 years and >/=65 years) to vaccine containing per dose 7.5 mug (children and adults), 15 mug (children and adults), or 30 mug (adults only) haemagglutinin in two placebo-controlled, observer-masked, multicentre phase 2 studies done in the USA. Participants were allocated with an interactive voice-response system or computer-generated randomisation lists with opaque scratchable patches. Primary outcome was haemagglutination inhibition antibody response 21 days after the first of two planned vaccinations (interim analysis of studies in progress). Analyses were by full-analysis set. The trials are registered with ClinicalTrials.gov as NCT00953524 and NCT00952419. FINDINGS: 410 of 423 children and 724 of 750 adults given an active vaccine, and 50 of 51 children and 95 of 99 adults given placebo were assessed for immunogenicity on day 21. After active vaccination, 45 of 101 (45%; 95% CI 35-55) to 47 of 94 (50%; 40-61) infants aged 6-35 months, 75 of 109 (69%; 59-77) to 80 of 106 (75%; 66-83) 3-9-year-old children, 134 of 141 (95%; 90-98) to 144 of 144 (100%; 98-100) of 18-64-year-old adults, and 93 of 100 (93%; 86-96) to 93 of 98 (95%; 89-98) elderly adults were seroprotected (proportion with titres >/=1:40). No vaccine-related serious adverse events occurred. Injection-site and systemic reactions were reported by up to about 50% of every age and vaccine group, with no noticeable differences between vaccine and placebo groups. INTERPRETATION: One dose of vaccine was highly immunogenic in adults, suggesting that it afforded sufficient protection against this pandemic influenza A H1N1 virus. Two doses of vaccine will probably be needed in children younger than 9 years. Safety and reactogenicity of the vaccine were acceptable and similar to those of seasonal vaccine. FUNDING: Office of the Assistant Secretary for Preparedness and Response, and Biomedical Advanced Research and Development Authority.

PMID: 20018365 [PubMed - as supplied by publisher]

[Read more →]

Towards Understanding Tight Glycemic Control in the ICU: A Systematic Review and Meta-analysis.

Chest. 2009 Dec 16;

Authors: Marik PE, Preiser JC

BACKGROUND: Following publication of the "Leuven Intensive Insulin Therapy Trial" in 2001, tight glycemic control became the standard of care in ICU's around the world. Recent studies suggest that this approach may be flawed OBJECTIVE: The goal of this systematic review was to determine the benefits and risks of tight glycemic control in ICU patients and to explain the differences in outcomes between reported trials. Data Sources: MEDLINE, Embase, the Cochrane Database of Systematic Reviews and citation review of relevant primary and review articles. Study Selection: Prospective, randomized, controlled clinical trials (RCT's) that studied the impact of tight glycemic control (blood glucose 80-110 mg/dl) on mortality in ICU patients. Data Extraction and analysis: Data were abstracted on study design, study size, patient characteristics as well as the mean (or median) and standard deviation of the ICU blood glucose level, mean daily dose of insulin administered, average daily caloric intake, percentage of calories given intravenously (parenteral nutrition), incidence of hypoglycemia, need for dialysis and 28 day/hospital mortality. Meta-analytic techniques were used to analyze the data; sub-group analysis and meta-regression were used to explain differences in the treatment effect. Data Synthesis: We identified 7 RCT's studies that included 11 425 patients. Overall, tight glycemic control did not reduce the 28 day mortality (OR 0.95; 95% CI 0.87-1.05), the incidence of blood stream infections (OR 1.04; 95% CI 0.93-1.17) nor the requirement for renal replacement therapy (OR 1.01; 95% CI 0.89-1.13). The incidence of hypoglycemia was significantly higher in patients randomized to tight glycemic control (OR 7.7; 95% CI 6.0-9.9, p< 0.001). Meta-regression demonstrated a significant relationship between the treatment effect (28 day mortality) and the proportion of calories provided parenterally (p=0.005). This suggests that difference in outcome between the two "Leuven Intensive Insulin Therapy Trials" and the subsequent trials could be related to the use of parenteral nutrition. When the two "Leuven Intensive Insulin Therapy Trials" are excluded from the meta-analysis, mortality was lower in the control patients (OR 0.90; 95% CI 0.81-0.99, p=0.04, I(2) =0%). CONCLUSIONS: There is no evidence to support the use of intensive insulin therapy in general medical-surgical ICU patients who are fed according to current guidelines. Tight glycemic control is associated with a high incidence of hypoglycemia and an increased risk of death in patients not receiving parenteral nutrition.

PMID: 20018803 [PubMed - as supplied by publisher]

[Read more →]

The effects of vasopressin and its analogues on the liver and its disorders in the critically ill.

Curr Opin Crit Care. 2009 Dec 16;

Authors: Asfar P, Radermacher P, Calès P, Oberti F

PURPOSE OF REVIEW: Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function. RECENT FINDINGS: A recent systematic meta-analysis of randomized trials suggests that terlipressin may improve renal function in hepatorenal syndrome and thereby reduce mortality by 34%. Moreover, a recent study reported that association of terlipressin and albumin was more effective than terlipressin alone. In patients with variceal bleeding, the bleeding control is significantly improved by early administration of terlipressin. The place of vasopressin in the treatment of patients with septic shock is still discussed, but compared with norepinephrine, vasopressin showed at least an equal efficacy. SUMMARY: The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.

PMID: 20019608 [PubMed - as supplied by publisher]

[Read more →]