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Vasopressin Therapy for Upper Gastrointestinal Tract Hemorrhage: Has Its Efficacy Been Proven?

Vasopressin Therapy for Upper Gastrointestinal Tract Hemorrhage: Has Its Efficacy Been Proven? Abstract • Of four reported studies of vasopressin therapy in acute upper gastrointestinal tract hemorrhage, three found vasopressin to be effective and one did not. The studies differed with regard to population, design, and methods. The one study that found vasopressin to be ineffective in controlling gastrointestinal tract hemorrhage may have been better controlled with regard to duration of therapy and evaluation of patients. However, the population studied appeared to be different and the authors may have failed to demonstrate a beneficial effect of vasopressin in a select subgroup of patients. Vasopressin dosing has also been a point of controversy. Hemodynamic data thus far support the use of low-dose infusions. The use of terlipressin (Glypressin), a new analogue of vasopressin, also appears promising. (Arch Intern Med 1985;145:1263-1267) References 1. Oliver G, Schafer EA: On the physiological action of the extracts of pituitary body and certain other glandular organs. J Physiol 1895;18:277. 2. Howell WH: The physiological effects of extracts of the hypophysis cerebri and infundibular body. J Exp Med 1889;3:245.Crossref 3. Shaldon S, Dallew W, Giurenara L, et al: Effect of Pitressin on the splanchic circulation in man. Circulation 1961;24:797-807.Crossref 4. Clark GA: Comparison of the effects of adrenalin and pituitrin on the portal circulation. J Physiol 1928;66:274-279. 5. Fogel MR, Knauer M, Andrew LL, et al: Continuous intravenous vasopressin in active upper gastrointestinal bleeding. Ann Intern Med 1982;96:565-569.Crossref 6. Schwartz S, Bales HW, Emerson GL, et al: The use of intravenous pituitrin in the treatment of bleeding esophageal varices. Surgery 1959;45:72-78. 7. Shaldon S, Sherlock S: The use of vasopressin in the control of bleeding from esophageal varices. Lancet 1960;2:222-225.Crossref 8. Conn HO, D'Alessio D: Multiple infusions of posterior pituitary extract in the treatment of bleeding esophageal varices. Ann Intern Med 1962;57:805-809.Crossref 9. Murray-Lyon I, Pugh R, Nunnerley J, et al: Treatment of bleeding esophageal varices by infusion of vasopressin into the superior mesenteric artery. Gut 1973;14:59-63.Crossref 10. Athanasoulis C, Baum S, Waltman A, et al: Control of acute gastric mucosal hemorrhage. N Engl J Med 1974;290:597-602.Crossref 11. Merigan TC, Poltkin GR, Davidson CS: Effect of intravenously administered posterior pituitary extract on hemorrhage from bleeding esophageal varices. N Engl J Med 1962;266:134-135.Crossref 12. Conn HO, Ramsby GR, Storer EH, et al: Intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage: A prospective controlled clinical trial. Gastroenterology 1975;68:211-221. 13. Mallory A, Schaefer JW, Cohen JR, et al: Selective intra-arterial vasopressin infusion of upper gastrointestinal tract hemorrhage. Arch Surg 1980;115:30-32.Crossref 14. Hernomo K, Boedhi-Darmojo R, Soemarto, et al: Vasopressin versus Sengstaken tube for bleeding varices: A prospective randomized controlled clinical trial, abstracted. Hepatology 1983;3:1058. 15. Kravetz D, Bosch J, Teres J: Comparison of intravenous somatostatin and vasopressin infusions in the treatment of acute variceal hemorrhage. Hepatology 1984;4:442-446.Crossref 16. Thomford N, Sirinek K: Intravenous vasopressin in patients with portal hypertension: Advantages of continuous infusion. J Surg Res 1975;18:113-117.Crossref 17. Barr J, Laken R, Rosch J: Similarity of arterial and intravenous vasopressin on portal and systemic hemodynamics. Gastroenterology 1975;69:13-19. 18. Freedman A, Kerr J, Swan K, et al: Primate mesenteric blood flow: Effects of vasopressin and its route of delivery. Gastroenterology 1978;74:875-878. 19. Chojkier M, Gorszmann RJ, Atterbury CE, et al: A controlled comparison of continuous intra-arterial and intravenous infusions of vasopressin in hemorrhage from esophageal varices. Gastroenterology 1979;77:540-546. 20. Burgener F, Guiterrez O: Intravenous versus superior mesenteric artery vasopressin infusions for the treatment of variceal bleeding. Radiology 1982;142:769-772.Crossref 21. Gaskill H, Sirinek K, Levine B: Hemodynamic effects of vasopressin: Can large doses be safely given? Arch Surg 1983;118:434-436.Crossref 22. Slotnick IL, Teiglang JD: Cardia.c accidents following vasopressin injection. JAMA 1951;146:1126-1129.Crossref 23. Reynolds T, Geller H, Redeker A: The effect of vasopressin on hepatic hemodynamics in patients with portal hypertension. J Clin Invest 1960;39:1021. 24. Ericsson B: Effect of vasopressin of the distribution of cardiac output and organ blood flow in the anesthetized dog. Acta Chir Scand 1971;137: 729-738. 25. Sirinek RK, Thomford N, Pace W: Adverse cardiodynamic effects of vasopressin not avoided by selective intra-arterial administration. Surgery 1977;81:723-728. 26. Nakano J: Studies of the cardiovascular effects of synthetic vasopressin. J Pharmacol Exp Ther 1967;157:19-31. 27. Corliss RJ, McKenna D, Sialer S, et al: Systemic and coronary hemodynamic effects of vasopressin. Am J Med Sci 1968;256:293-299.Crossref 28. Drapanas T, Crowe CP, Shim WKT, et al: The effect of Pitressin on the cardiac output and coronary, hepatic, and intestinal blood flow. Surg Gynecol Obstet 1961;113:484-489. 29. Ericsson B: Early effect of vasopressin on the coronary circulation in normovolemic and hypovolemic dogs. Acta Chir Scand 1972;138:235-238. 30. Groszmann RJ, Kravetz D, Bosch J, et al: Nitroglycerin improves the hemodynamic response to vasopressin in portal hypertension. Hepatology 1982;2:757-762.Crossref 31. Cort JH, Albrecht I, Novakova J, et al: Regional and systemic hemodynamic effects of some vasopressins: Structural features of the hormone which prolongs activity. Eur J Clin Invest 1975;5:165-175.Crossref 32. Lauson HD: Metabolism of antidiuretic hormone. Am J Med 1967;42:713.Crossref 33. Rychlik I: Inactivation of oxytocin and vasopressin by tissue enzymes: A basis for the design of analogues , in Rudinger J (ed): Oxytocin, Vasopressin and Their Structural Analogues . New York, Pergamon Press, 1964, vol 10, p 153. 34. Marks N, Abrash L, Walter R: Degradation of neurohypophysial hormones by brain extracts and purified brain extracts and purified brain enzymes. Proc Soc Exp Biol Med 1973;142:455.Crossref 35. Lauson H: Metabolism of the neurohypophysial hormones , in Knobil E (ed): Handbook of Physiology . Baltimore, American Physiological Society, 1974, vol 4, chap 14. 36. Fabian M: The clearance and antidiuretic potency of neurohypophysial hormones in man, and their plasma binding and stability. J Physiol 1969;204:653-668. 37. Klein L: Antidiuretic hormone metabolism studied by radioimmunoassay. Surg Forum 1967;18:189-191. 38. Klein L: The metabolism of arginine-vasopressin and radioactive iodovasopressin. Program of the Second Annual Meeting of the American Society of Nephrology, Washington, DC, Nov 25, 1968, p 31. 39. Pliska V, Chard T, Rodinger J, et al: In vivo activation of synthetic hormogens of lysine vasopressin: N-glycyl-glycyl-glycyl-8-lysine vasopressin in the cat. Acta Endocrinol 1976;81:474-481. 40. Cort JH, Jeanjean MF, Thomson AE, et al: Effects of 'hormonogen' forms of neurohypophysial peptides in hemorrhagic shock in dogs. Am J Physiol 1968;214:455-462. 41. Douglas JG, Forrest JAH, Prowse CV, et al: Effects of lysine vasopressin and glypressin on the fibrinolytic system in cirrhosis. Gut 1979;20:565-567.Crossref 42. Prowse CV, Douglas JG, Forsling ML: Hemostatic effects of lysine vasopressin and triglycyl lysine vasopressin infusion in patients with cirrhosis. Eur J Clin Invest 1980;10:49-54.Crossref 43. Gader AMA, DeCosta J, Cash JD: A new vasopressin analogue and fibrinolysis. Lancet 1973;2:1417-1418.Crossref 44. Freeman JG, Lishman AH, Cobden I, et al: Controlled trial of terlipressin (Glypressin) versus vasopressin in the early treatment of oesophageal varices. Lancet 1982;2:66-68.Crossref 45. Vosmik J, Jedlicka K, Mulder JL, et al: Action of the triglycyl hormonogen of vasopressin (Glypressin) in patients with liver cirrhosis and bleeding esophageal varices. Gastroenterology 1977;72:605-609. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Vasopressin Therapy for Upper Gastrointestinal Tract Hemorrhage: Has Its Efficacy Been Proven?

Hussey, Keith P.
Archives of Internal Medicine , Volume 145 (7) – Jul 1, 1985
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Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360070143024
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Abstract

Abstract • Of four reported studies of vasopressin therapy in acute upper gastrointestinal tract hemorrhage, three found vasopressin to be effective and one did not. The studies differed with regard to population, design, and methods. The one study that found vasopressin to be ineffective in controlling gastrointestinal tract hemorrhage may have been better controlled with regard to duration of therapy and evaluation of patients. However, the population studied appeared to be different and the authors may have failed to demonstrate a beneficial effect of vasopressin in a select subgroup of patients. Vasopressin dosing has also been a point of controversy. Hemodynamic data thus far support the use of low-dose infusions. The use of terlipressin (Glypressin), a new analogue of vasopressin, also appears promising. (Arch Intern Med 1985;145:1263-1267) References 1. Oliver G, Schafer EA: On the physiological action of the extracts of pituitary body and certain other glandular organs. J Physiol 1895;18:277. 2. Howell WH: The physiological effects of extracts of the hypophysis cerebri and infundibular body. J Exp Med 1889;3:245.Crossref 3. Shaldon S, Dallew W, Giurenara L, et al: Effect of Pitressin on the splanchic circulation in man. Circulation 1961;24:797-807.Crossref 4. Clark GA: Comparison of the effects of adrenalin and pituitrin on the portal circulation. J Physiol 1928;66:274-279. 5. Fogel MR, Knauer M, Andrew LL, et al: Continuous intravenous vasopressin in active upper gastrointestinal bleeding. Ann Intern Med 1982;96:565-569.Crossref 6. Schwartz S, Bales HW, Emerson GL, et al: The use of intravenous pituitrin in the treatment of bleeding esophageal varices. Surgery 1959;45:72-78. 7. Shaldon S, Sherlock S: The use of vasopressin in the control of bleeding from esophageal varices. Lancet 1960;2:222-225.Crossref 8. Conn HO, D'Alessio D: Multiple infusions of posterior pituitary extract in the treatment of bleeding esophageal varices. Ann Intern Med 1962;57:805-809.Crossref 9. Murray-Lyon I, Pugh R, Nunnerley J, et al: Treatment of bleeding esophageal varices by infusion of vasopressin into the superior mesenteric artery. Gut 1973;14:59-63.Crossref 10. Athanasoulis C, Baum S, Waltman A, et al: Control of acute gastric mucosal hemorrhage. N Engl J Med 1974;290:597-602.Crossref 11. Merigan TC, Poltkin GR, Davidson CS: Effect of intravenously administered posterior pituitary extract on hemorrhage from bleeding esophageal varices. N Engl J Med 1962;266:134-135.Crossref 12. Conn HO, Ramsby GR, Storer EH, et al: Intra-arterial vasopressin in the treatment of upper gastrointestinal hemorrhage: A prospective controlled clinical trial. Gastroenterology 1975;68:211-221. 13. Mallory A, Schaefer JW, Cohen JR, et al: Selective intra-arterial vasopressin infusion of upper gastrointestinal tract hemorrhage. Arch Surg 1980;115:30-32.Crossref 14. Hernomo K, Boedhi-Darmojo R, Soemarto, et al: Vasopressin versus Sengstaken tube for bleeding varices: A prospective randomized controlled clinical trial, abstracted. Hepatology 1983;3:1058. 15. Kravetz D, Bosch J, Teres J: Comparison of intravenous somatostatin and vasopressin infusions in the treatment of acute variceal hemorrhage. Hepatology 1984;4:442-446.Crossref 16. Thomford N, Sirinek K: Intravenous vasopressin in patients with portal hypertension: Advantages of continuous infusion. J Surg Res 1975;18:113-117.Crossref 17. Barr J, Laken R, Rosch J: Similarity of arterial and intravenous vasopressin on portal and systemic hemodynamics. Gastroenterology 1975;69:13-19. 18. Freedman A, Kerr J, Swan K, et al: Primate mesenteric blood flow: Effects of vasopressin and its route of delivery. Gastroenterology 1978;74:875-878. 19. Chojkier M, Gorszmann RJ, Atterbury CE, et al: A controlled comparison of continuous intra-arterial and intravenous infusions of vasopressin in hemorrhage from esophageal varices. Gastroenterology 1979;77:540-546. 20. Burgener F, Guiterrez O: Intravenous versus superior mesenteric artery vasopressin infusions for the treatment of variceal bleeding. Radiology 1982;142:769-772.Crossref 21. Gaskill H, Sirinek K, Levine B: Hemodynamic effects of vasopressin: Can large doses be safely given? Arch Surg 1983;118:434-436.Crossref 22. Slotnick IL, Teiglang JD: Cardia.c accidents following vasopressin injection. JAMA 1951;146:1126-1129.Crossref 23. Reynolds T, Geller H, Redeker A: The effect of vasopressin on hepatic hemodynamics in patients with portal hypertension. J Clin Invest 1960;39:1021. 24. Ericsson B: Effect of vasopressin of the distribution of cardiac output and organ blood flow in the anesthetized dog. Acta Chir Scand 1971;137: 729-738. 25. Sirinek RK, Thomford N, Pace W: Adverse cardiodynamic effects of vasopressin not avoided by selective intra-arterial administration. Surgery 1977;81:723-728. 26. Nakano J: Studies of the cardiovascular effects of synthetic vasopressin. J Pharmacol Exp Ther 1967;157:19-31. 27. Corliss RJ, McKenna D, Sialer S, et al: Systemic and coronary hemodynamic effects of vasopressin. Am J Med Sci 1968;256:293-299.Crossref 28. Drapanas T, Crowe CP, Shim WKT, et al: The effect of Pitressin on the cardiac output and coronary, hepatic, and intestinal blood flow. Surg Gynecol Obstet 1961;113:484-489. 29. Ericsson B: Early effect of vasopressin on the coronary circulation in normovolemic and hypovolemic dogs. Acta Chir Scand 1972;138:235-238. 30. Groszmann RJ, Kravetz D, Bosch J, et al: Nitroglycerin improves the hemodynamic response to vasopressin in portal hypertension. Hepatology 1982;2:757-762.Crossref 31. Cort JH, Albrecht I, Novakova J, et al: Regional and systemic hemodynamic effects of some vasopressins: Structural features of the hormone which prolongs activity. Eur J Clin Invest 1975;5:165-175.Crossref 32. Lauson HD: Metabolism of antidiuretic hormone. Am J Med 1967;42:713.Crossref 33. Rychlik I: Inactivation of oxytocin and vasopressin by tissue enzymes: A basis for the design of analogues , in Rudinger J (ed): Oxytocin, Vasopressin and Their Structural Analogues . New York, Pergamon Press, 1964, vol 10, p 153. 34. Marks N, Abrash L, Walter R: Degradation of neurohypophysial hormones by brain extracts and purified brain extracts and purified brain enzymes. Proc Soc Exp Biol Med 1973;142:455.Crossref 35. Lauson H: Metabolism of the neurohypophysial hormones , in Knobil E (ed): Handbook of Physiology . Baltimore, American Physiological Society, 1974, vol 4, chap 14. 36. Fabian M: The clearance and antidiuretic potency of neurohypophysial hormones in man, and their plasma binding and stability. J Physiol 1969;204:653-668. 37. Klein L: Antidiuretic hormone metabolism studied by radioimmunoassay. Surg Forum 1967;18:189-191. 38. Klein L: The metabolism of arginine-vasopressin and radioactive iodovasopressin. Program of the Second Annual Meeting of the American Society of Nephrology, Washington, DC, Nov 25, 1968, p 31. 39. Pliska V, Chard T, Rodinger J, et al: In vivo activation of synthetic hormogens of lysine vasopressin: N-glycyl-glycyl-glycyl-8-lysine vasopressin in the cat. Acta Endocrinol 1976;81:474-481. 40. Cort JH, Jeanjean MF, Thomson AE, et al: Effects of 'hormonogen' forms of neurohypophysial peptides in hemorrhagic shock in dogs. Am J Physiol 1968;214:455-462. 41. Douglas JG, Forrest JAH, Prowse CV, et al: Effects of lysine vasopressin and glypressin on the fibrinolytic system in cirrhosis. Gut 1979;20:565-567.Crossref 42. Prowse CV, Douglas JG, Forsling ML: Hemostatic effects of lysine vasopressin and triglycyl lysine vasopressin infusion in patients with cirrhosis. Eur J Clin Invest 1980;10:49-54.Crossref 43. Gader AMA, DeCosta J, Cash JD: A new vasopressin analogue and fibrinolysis. Lancet 1973;2:1417-1418.Crossref 44. Freeman JG, Lishman AH, Cobden I, et al: Controlled trial of terlipressin (Glypressin) versus vasopressin in the early treatment of oesophageal varices. Lancet 1982;2:66-68.Crossref 45. Vosmik J, Jedlicka K, Mulder JL, et al: Action of the triglycyl hormonogen of vasopressin (Glypressin) in patients with liver cirrhosis and bleeding esophageal varices. Gastroenterology 1977;72:605-609.

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Archives of Internal Medicine – American Medical Association

Published: Jul 1, 1985

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