Efficacy and safety of terlipressin infusion during liver surgery: a meta-analysis.
Lin Ding, Yi Duan, Zuozhi Li et al.
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In 30 seconds
This systematic review and meta-analysis assessed perioperative terlipressin (TP) in liver surgery, focusing on estimated blood loss (EBL) and transfusion requirements. Across 12 studies involving 988 subjects, TP was not associated with significant overall reductions in EBL, red blood cell transfusion volume, or fresh frozen plasma transfusion volume. In a subgroup analysis, continuous TP infusion was associated with lower intraoperative EBL (weighted mean difference [WMD] = -336.22; 95% CI, -562.13 to -110.31; P = 0.004). The authors conclude that TP does not reduce these outcomes overall, although continuous infusion may lower EBL.
Key findings
- Overall EBL did not differ significantly with TP (WMD = -99.09; 95% CI, -318.41 to 120.24; P = 0.38).
- RBC transfusion volume (SMD = -0.10; 95% CI = -0.74 to 0.54; P = 0.76) and FFP transfusion volume (SMD = 0.07; 95% CI = -0.24 to 0.37; P = 0.67) showed no significant differences.
- Continuous TP infusion was associated with reduced intraoperative EBL in subgroup analysis (WMD = -336.22; 95% CI, -562.13 to -110.31; P = 0.004).
Why it matters
Bleeding and transfusion are important perioperative outcomes in liver surgery, but this pooled evidence does not show an overall benefit from TP. The subgroup result suggests that administration method may matter, while the absence of an overall effect cautions against treating the continuous-infusion finding as evidence of benefit across TP use generally.
What to keep in mind
The meta-analysis included only English-language publications, and the abstract does not report the designs or quality of the included studies. The continuous-infusion result comes from subgroup analysis.