Appropriateness of terlipressin use and its association with clinical efficacy and safety: A real-world cohort study of 240 hospitalized patients

This study aimed to evaluate the appropriateness of terlipressin use and assess its effects on coagulation parameters in 240 hospitalized patients treated between January 2024 and January 2025 in a real-world, single-center retrospective cohort. Clinical appropriateness, encompassing diagnostic indication, initial dosing, and administration route, was rigorously evaluated against current clinical guidelines and the manufacturer's prescribing information. Key coagulation parameters - prothrombin time, thrombin time, activated partial thromboplastin time, and fibrinogen - were analyzed before and after treatment using paired-sample t tests, and patients were stratified into short-course (≤5 days) and long-course (≥6 days) therapy groups to examine the impact of treatment duration on outcomes using independent-sample t tests. The analysis revealed a high degree of appropriateness: 231 patients (96.3%) received terlipressin for guideline-consistent indications, 143 patients (59.6%) were administered the recommended initial bolus dose of 2 mg, and 185 cases (77.1%) employed the advised slow intravenous infusion route. Treatment with terlipressin significantly improved coagulation, with prothrombin time decreasing by a mean of 1.43 seconds and fibrinogen increasing by 0.11 g/L (both P < .01). However, extending the treatment course beyond 5 days offered no additional coagulation benefit, as no parameters showed significant improvement in the long-course compared with the short-course group (all P > .05). These results underscore that terlipressin use was largely appropriate for indication and route, but extending therapy beyond 5 days provided no additional coagulation benefit. This finding supports stricter adherence to guideline-recommended treatment duration to promote more rational and effective use of terlipressin in clinical practice.