Format

Send to

Choose Destination
See comment in PubMed Commons below
J Hepatol. 2013 Jan;58(1):45-50. doi: 10.1016/j.jhep.2012.08.020. Epub 2012 Aug 30.

Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study.

Author information

1
Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain. jcgarcia@clinic.ub.es

Abstract

BACKGROUND & AIMS:

In a recent randomized international clinical trial (RCT) in high-risk cirrhotic patients with acute variceal bleeding, the early use of transjugular intrahepatic portosystemic shunt (TIPS) was associated with marked and significant reductions in both treatment failure and mortality. The aim of this study was to confirm these results in clinical practice in the same centers of the RCT study.

METHODS:

We retrospectively reviewed patients admitted for acute variceal bleeding and high risk of treatment failure (Child C <14 or Child B plus active bleeding), treated with early-TIPS (n=45) or drugs+endoscopic therapy (ET) (n=30).

RESULTS:

Patients treated with early-TIPS had a much lower incidence of failure to control bleeding or rebleeding than patients receiving drug+ET (3 vs. 15; p <0.001). The 1-year actuarial probability of remaining free of this composite end point was 93% vs. 53% (p <0.001). The same was observed in mortality (1-year actuarial survival was 86% vs. 70% respectively; p=0.056). Actuarial curves of failure to control bleeding+rebleeding and of survival were well within the confidence intervals of those observed in the RCT.

CONCLUSIONS:

This study supports the early use of TIPS in patients with cirrhosis and a high-risk variceal bleeding.

PMID:
22940408
DOI:
10.1016/j.jhep.2012.08.020
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center