Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting

Chalasani, Naga; Clark, W.Scott; Martin, Louis G.; Kamean, Jeffrie; Khan, M.Abdul; Patel, Nilesh H.; Boyer, Thomas D.

doi:10.1016/s0016-5085(00)70422-7

Cited by 202 publications

(149 citation statements)

References 22 publications

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“…2,[10][11][12][13] Such treatments are effective in bleeding control, but require expertise and are associated with complications and high mortality, particularly in patients with poor liver function. [14][15][16][17][18] In patients with cirrhosis, compromised hepatic function results in decreased synthesis of coagulation factors, notably factor VII (FVII). 19 Coagulopathy may therefore be associated with failure to control variceal bleeding and promotion of rebleeding, 8,[20][21][22] and patients might thus benefit from a drug that could correct the coagulopathy and restore hemostasis.…”

mentioning

confidence: 99%

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

et al. 2008

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on behalf of the International Study Group on rFVIIa in UGI Hemorrhage A beneficial effect of recombinant activated factor VII (rFVIIa) in Child-Pugh class B and C patients with cirrhosis who have variceal bleeding has been suggested. This randomized controlled trial assessed the efficacy and safety of rFVIIa in patients with advanced cirrhosis and active variceal bleeding. At 31 hospitals in an emergency setting, 256 patients (Child-Pugh > 8; Child-Pugh B ‫؍‬ 26%, C ‫؍‬ 74%) were randomized equally to: placebo; 600 g/kg rFVIIa (200 ؉ 4؋ 100 g/kg); or 300 g/kg rFVIIa (200 ؉ 100 g/kg). Dosing was intravenous at 0, 2, 8, 14, and 20 hours after endoscopy, in addition to standard vasoactive, prophylactic antibiotic, and endoscopic treatment. The primary composite endpoint consisted of failure to control 24-hour bleeding, or failure to prevent rebleeding or death at day 5. Secondary endpoints included adverse events and 42-day mortality. Baseline characteristics were comparable between groups. Administration of rFVIIa had no significant effect on the composite endpoint compared with placebo (P ‫؍‬ 0.37). There was no significant difference in 5-day mortality between groups; however, 42-day mortality was significantly lower with 600 g/kg rFVIIa compared with placebo (odds ratio 0.31, 95% confidence interval ‫؍‬ 0.13-0.74), and bleeding-related deaths were reduced from 12% (placebo) to 2% (600 g/kg). A marked heterogeneity in the failure rate in all treatment groups was observed across participating centers. Adverse events, including overall thromboembolic events, were comparable between groups. Conclusion: Treatment with rFVIIa had no significant effect on the primary composite endpoint compared with placebo. Therefore, decision on the use of this hemostatic agent in acute variceal bleeding should be carefully considered, because results of this study do not support the routine use of rFVIIa in this setting. Adverse events were comparable across groups. (HEPATOLOGY 2008;47:1604-1614

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confidence: 99%

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

et al. 2008

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“…The procedure is carried out by intervening radiologic technique, with percutaneous puncture of the internal jugular vein and, creation of an intrahepatic communication between a branch of the portal vein and the hepatic vein with the insertion of an expandable metallic stent in the parenchymatous path (9) , and its success rate is approximately 90% (3) . Despite TIPS success in decompressing portal vein, the hepatic function may worsen after the procedure, early mortality reported is from 3% to 44% (5,20) and the mortality rate in one year is from 10% to 58% (5) . Recent studies show that factors associated with bad prognosis in patients who underwent TIPS include previous encephalopathy, Chil dPugh class C, emergency TIPS and MELD > 18, being these mortality predictors (5,10,20,24,28) .…”

Section: Mortality and Complications In Patients With Portal Hypertenmentioning

confidence: 99%

“…Despite TIPS success in decompressing portal vein, the hepatic function may worsen after the procedure, early mortality reported is from 3% to 44% (5,20) and the mortality rate in one year is from 10% to 58% (5) . Recent studies show that factors associated with bad prognosis in patients who underwent TIPS include previous encephalopathy, Chil dPugh class C, emergency TIPS and MELD > 18, being these mortality predictors (5,10,20,24,28) . TIPS complications divide in those concerning its installation and immediate and late hemodynamic consequences which occur in about 10% of patients being mostly mild (6,23) .…”

Section: Mortality and Complications In Patients With Portal Hypertenmentioning

confidence: 99%

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Funes

Silva

Arroyo

et al. 2012

Arq. Gastroenterol.

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-Context -Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. ). Global mortality occurred in 41 (60.3%). Conclusions -Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis. HEADINGS -Portasystemic shunt, transjugular intrahepatic. Hypertension, portal.Estudo não apresenta conflito de interesses.

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“…Examples of this include palliative treatment for HCC patients with refractory variceal bleeding, recanalization of occluded portal veins in patients with recurrent variceal bleeding, and treatment of patients with BCS and progressive liver failure. In addition, patients with a history of HE are at an increased risk for exacerbation of HE after shunt creation 93 and they should be aware of this risk-benefit scenario There have been numerous models created in predicting post-TIPS survival 94,95,96,97,98 . Among these, the modified Model for End-Stage Liver Disease score (MELD) 99 has proved to be superior to CPT score and Emory score 101 .…”

Section: Patient Selection and Pre-tips Evaluationmentioning

confidence: 99%

“…The pathophysiology of post-TIPS HE is complex, though mainly due to diverted portal flow away from the liver due to TIPS and into the arterial system 95,114 and decreased liver metabolic capacity. Frequency of new or worsening HE ranges from 10-44% 3 , and factors associated with post-TIPS HE development include prior history of HE, increasing age, shunt caliber, high creatinine levels, low serum sodium concentration and liver dysfunction 95,115 . Previously, studies with bare metal stents found an increased risk for the development of HE after TIPS insertion for ascites 57,58,59,60,61,62 .…”

Section: Portosystemic Shunting Relatedmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt

Preedy¹,

Watson²

2010

Handbook of Disease Burdens and Quality of Life Measures

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Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for the complications of portal hypertension. The largest body of evidence for its use has been supported for recurrent or refractory variceal bleeding and refractory ascites. Its use has also been advocated for acute variceal bleed, hepatic hydrothorax, and hepatorenal syndrome. With the replacement of bare metal stents with polytetrafluoroethylen (PTFE) covered stents, shunt patency has improved dramatically thus improving outcomes. Therefore, reassessment of its utility, management of its complications, and understanding of various TIPS techniques is important.

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Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting

Cited by 202 publications

References 22 publications

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Transjugular Intrahepatic Portosystemic Shunt

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