Midodrine Versus Albumin in the Prevention of Paracentesis-Induced Circulatory Dysfunction in Cirrhotics: A Randomized Pilot Study

Singh, Virendra; Dheerendra, Prashant; Singh, Baljinder; Nain, C. K.; Chawla, Divya; Sharma, Navneet; Bhalla, Ashish; Mahi, Sushil

doi:10.1111/j.1572-0241.2008.01787.x

Cited by 75 publications

(69 citation statements)

References 22 publications

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“…However, recent studies have shown that administration of vasoconstrictors such as terlipressin or noradrenaline may also be effective either alone or in combination with albumin [48,84,85]. In a recent study, the vasoconstrictor midodrine was as effective as albumin to prevent PICD, but at a lower cost [86]. The PICD is an example of a condition where complications attributable to a potentially reduced effective blood volume can be prevented by a specific volume support.…”

Section: Treatment Of Refractory Ascitesmentioning

confidence: 96%

Pathogenetic background for treatment of ascites and hepatorenal syndrome

2008

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Ascites and hepatorenal syndrome (HRS) are the major and challenging complications of cirrhosis and portal hypertension that significantly affect the course of the disease. Liver insufficiency, portal hypertension, arterial vasodilatation, and systemic cardiovascular dysfunction are major pathophysiological hallmarks. Modern treatment of ascites is based on this recognition and includes modest salt restriction and stepwise diuretic therapy with spironolactone and loop diuretics. Tense and refractory ascites should be treated with a large volume paracentesis, followed by volume expansion or transjugular intrahepatic portosystemic shunt. New treatment strategies include the use of vasopressin V(2)-receptor antagonists and vasoconstrictors. The HRS denotes a functional and reversible impairment of renal function in patients with severe cirrhosis with a poor prognosis. Attempts of treatment should seek to improve liver function, ameliorate arterial hypotension and central hypovolemia, and reduce renal vasoconstriction. Ample treatment of ascites and HRS is important to improve the quality of life and prevent further complications, but since treatment of fluid retention does not significantly improve survival, these patients should always be considered for liver transplantation.

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Section: Treatment Of Refractory Ascitesmentioning

confidence: 96%

Pathogenetic background for treatment of ascites and hepatorenal syndrome

2008

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“…120 Three randomized studies, with 20, 40, and 49 patients, respectively, have compared terlipressin (1 mg/8 hours three times, or 1 mg/4 hours for 48 hours) and albumin (8 g/L of ascites removed) in the prevention of paracentesis-induced circulatory dysfunction. [121][122][123] All studies found terlipressin and albumin to be equally effective.…”

Section: Terlipressin In the Prevention Of Paracentesis-induced Circumentioning

confidence: 99%

Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome

et al. 2008

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Terlipressin is an analog of the natural hormone arginine-vasopressin. It is used in the treatment of patients with cirrhosis and bleeding esophageal varices (BEV) and in patients with hepatorenal syndrome (HRS): two of the most dramatic and feared complications of cirrhosis. Terlipressin exerts its main pharmacological effect through stimulation of vasopressin-1 receptors. These receptors are located in vascular smooth muscle and mediate vasoconstriction. In patients with cirrhosis and portal hypertension, treatment with terlipressin increases mean arterial pressure and decreases portal flow and pressure within minutes of administration. Furthermore, in patients with ascites terlipressin improves glomerular filtration and excretion of sodium. Terlipressin decreases failure of initial hemostasis by 34%, decreases mortality by 34%, and is considered a first-line treatment for BEV, when available. Terlipressin in combination with albumin reverses type 1 HRS in 33%-60% of cases and is the only treatment with proven efficacy in randomized trials. The safety profile is favorable when considering the clinical efficacy and the high mortality of these clinical entities. Adverse events are mostly cardiovascular and related to vasoconstriction. Mortality and withdrawal of terlipressin due to adverse events occurs in less than 1% of cases. Mild adverse events related to terlipressin treatment occur in 10%-20% of patients. The benefit, however, of terlipressin on long-term survival in HRS remains to be determined. At present, treatment with terlipressin and albumin is considered the most efficient therapy and should therefore be recommended for the treatment of type 1 HRS-1.

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“…Around 20% of these patients develop dilutional hyponatremia secondary to hepatorenal syndrome and/or water retention. The portal pressure usually rises in patients developing circulatory dysfunction after LVP, probably due to a raised intrahepatic resistance due to the action of vasoconstrictor systems on the hepatic vascular bed [46][47][48][49][50][51][52][53][54]. Finally and most importantly, circulatory dysfunction is usually linked to decreased survival [44,53].…”

Section: Intravenous Albuminmentioning

confidence: 99%

“…Vasoconstrictors such as the α1-adrenergic agonist midodrine or terlipressin improve circulatory and renal function in patients with and without refractory ascites. Terlipressin is given in intravenous boluses (1 mg at onset of paracentesis, 1 mg at 8 h and 1 mg at 16 h) in addition to oral midodrine (for 72 h post-paracentesis), which appear to be as good as albumin in suppressing plasma renin elevation in randomized trials; terlipressin is not commercially offered in the United States [51,68,69].…”

Section: Other Treatment Optionsmentioning

confidence: 99%

Pharmacological Therapy of Ascites

Ajlan¹,

Al–Hamoudi²,

Elsiesy³

2017

Ascites - Physiopathology, Treatment, Complications and Prognosis

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Ascites refer to accumulation of fluids in the peritoneal cavity. Ascites is caused by multiple causes, among which liver cirrhosis is the commonest. Confirming the etiology is the first and most important step toward proper management. Assuming that ascites is always caused by cirrhosis can lead to unnecessarily sending patients with different etiologies for liver transplantation, particularly patients with non-cirrhotic portal hypertension. Calculating serum albumin ascitic gradient is important in differentiating ascites due to portal hypertension from other etiologies. The first-line therapy for ascites in cirrhosis is low salt diet and diuretics. It is important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and nephrotoxic medications in these patients.

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Midodrine Versus Albumin in the Prevention of Paracentesis-Induced Circulatory Dysfunction in Cirrhotics: A Randomized Pilot Study

Abstract: The study suggests that midodrine may be as effective as albumin in preventing PICD in cirrhotics, but at a fraction of the cost, and can be administered orally. Midodrine also resulted in an increase in 24-h urine volume and sodium excretion.

Cited by 75 publications

References 22 publications

Pathogenetic background for treatment of ascites and hepatorenal syndrome

Pathogenetic background for treatment of ascites and hepatorenal syndrome

Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome

Pharmacological Therapy of Ascites

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