Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis
Introduction and Objectives: Lorazepam is the first-line treatment in patients with alcohol withdrawal syndrome (AWS). In patients with cirrhosis and AWS, the use of dexmetomidine (DXM) has been poorly studied. The objective of this study is to report the effect of DXM in patients with cirrhosis and...
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Elsevier
2025-04-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268125000195 |
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| author | Liliana I. Gallardo-González Jose L. Perez-Hernandez Maria F. Higuera-De la Tijera Mary C. Alegría-Ovando |
| author_facet | Liliana I. Gallardo-González Jose L. Perez-Hernandez Maria F. Higuera-De la Tijera Mary C. Alegría-Ovando |
| author_sort | Liliana I. Gallardo-González |
| collection | DOAJ |
| description | Introduction and Objectives: Lorazepam is the first-line treatment in patients with alcohol withdrawal syndrome (AWS). In patients with cirrhosis and AWS, the use of dexmetomidine (DXM) has been poorly studied. The objective of this study is to report the effect of DXM in patients with cirrhosis and AWS. Materials and Patients: Observational, retrospective, descriptive and analytical study. Patients with cirrhosis and AWS, treated with lorazepam, DXM, or both, were included. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) data was collected before and after treatment, as well as the days of in-hospital stay (IHS). The quantitative variables were summarized using non-parametric descriptive statistics according to the distribution of the variables (average and range), as well as frequencies and percentages in the case of qualitative variables. To compare between three independent groups, the Kruskal-Wallis (KW) and Jonckheere-Terpstra (JT) tests were used. A significant difference was considered one with a value of p<0.05. Results: 39 patients were included, 37 (94.9%) men, average age 41 (27-66) years, alcohol consumption 287 (64-960) g/day, CIWA-Ar at admission 20 (10-46) points, Child -Pugh 10 (5-14) points, MELD-Na 16 (8-40) points. Regarding the AWS treatment: 17 (43.6%) received lorazepam, 13 (33.3%) DXM, and 9 (23.1%) lorazepam + DXM. When compared between groups there were no differences in terms of days of IHS [4 (1-30) vs. 3 (1-18) vs. 2 (1-5) respectively for lorazepam, DXM, lorazepam + DXM; KW p=0.86, JT p=0.82], nor in terms of CIWA-Ar at 24 hours post-treatment [7 (1-19) vs. 6 (0-15) vs. 5 (2-23) respectively for lorazepam, DXM, lorazepam + DXM; KW p=0.19, JT p=0.45]. No serious adverse effects were reported with any of the three strategies. Conclusions: DXM appears to be an effective and safe option for the treatment of AWS in patients with cirrhosis. However, clinical trials are required to validate our findings. |
| format | Article |
| id | doaj-art-af29a79fcc5b401ba860ce798d7bd8d2 |
| institution | OA Journals |
| issn | 1665-2681 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | Annals of Hepatology |
| spelling | doaj-art-af29a79fcc5b401ba860ce798d7bd8d22025-08-20T02:13:53ZengElsevierAnnals of Hepatology1665-26812025-04-013010179510.1016/j.aohep.2025.101795Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosisLiliana I. Gallardo-González0Jose L. Perez-Hernandez1Maria F. Higuera-De la2 Tijera3Mary C. Alegría-Ovando4Department of Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, MexicoDepartment of Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, MexicoDepartment of Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, MexicoDepartment of Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, MexicoDepartment of Gastroenterology and Hepatology. General Hospital of Mexico “Dr. Eduardo Liceaga.” Mexico City, MexicoIntroduction and Objectives: Lorazepam is the first-line treatment in patients with alcohol withdrawal syndrome (AWS). In patients with cirrhosis and AWS, the use of dexmetomidine (DXM) has been poorly studied. The objective of this study is to report the effect of DXM in patients with cirrhosis and AWS. Materials and Patients: Observational, retrospective, descriptive and analytical study. Patients with cirrhosis and AWS, treated with lorazepam, DXM, or both, were included. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) data was collected before and after treatment, as well as the days of in-hospital stay (IHS). The quantitative variables were summarized using non-parametric descriptive statistics according to the distribution of the variables (average and range), as well as frequencies and percentages in the case of qualitative variables. To compare between three independent groups, the Kruskal-Wallis (KW) and Jonckheere-Terpstra (JT) tests were used. A significant difference was considered one with a value of p<0.05. Results: 39 patients were included, 37 (94.9%) men, average age 41 (27-66) years, alcohol consumption 287 (64-960) g/day, CIWA-Ar at admission 20 (10-46) points, Child -Pugh 10 (5-14) points, MELD-Na 16 (8-40) points. Regarding the AWS treatment: 17 (43.6%) received lorazepam, 13 (33.3%) DXM, and 9 (23.1%) lorazepam + DXM. When compared between groups there were no differences in terms of days of IHS [4 (1-30) vs. 3 (1-18) vs. 2 (1-5) respectively for lorazepam, DXM, lorazepam + DXM; KW p=0.86, JT p=0.82], nor in terms of CIWA-Ar at 24 hours post-treatment [7 (1-19) vs. 6 (0-15) vs. 5 (2-23) respectively for lorazepam, DXM, lorazepam + DXM; KW p=0.19, JT p=0.45]. No serious adverse effects were reported with any of the three strategies. Conclusions: DXM appears to be an effective and safe option for the treatment of AWS in patients with cirrhosis. However, clinical trials are required to validate our findings.http://www.sciencedirect.com/science/article/pii/S1665268125000195 |
| spellingShingle | Liliana I. Gallardo-González Jose L. Perez-Hernandez Maria F. Higuera-De la Tijera Mary C. Alegría-Ovando Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis Annals of Hepatology |
| title | Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| title_full | Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| title_fullStr | Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| title_full_unstemmed | Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| title_short | Experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| title_sort | experience with dexmetomidine in the management of alcohol withdrawal syndrome for patients with cirrhosis |
| url | http://www.sciencedirect.com/science/article/pii/S1665268125000195 |
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