Early Shunting Controls Bleeding in Cirrhotic Patients

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Early Shunting Controls Bleeding in Cirrhotic Patients

Treatment may reduce morbidity and mortality in patients with variceal bleedingWEDNESDAY, June 23 Typically reserved as a rescue therapy, the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) soon after hospital admittance for acute variceal bleeding in cirrhosis patients may reduce the likelihood of treatment failure and death, according to research published in the June 24 issue of the New England Journal of Medicine. García-Pagán, M.D., of the University of Barcelona in Spain, and colleagues randomly assigned 63 patients with cirrhosis and acute variceal bleeding who had received vasoactive drug therapy to receive either a polytetrafluoroethylene-covered stent within three days (early-TIPS group) or continued treatment with vasoactive drugs followed by beta blockers and endoscopic band ligation (pharmacotherapy-EBL group).In a median

follow-up of 16 months, only one patient in the early-TIPS group had bleeding, compared to 14 patients in the pharmacotherapy-EBL group; four patients from the early-TIPS group died, versus 12 in the pharmacotherapy-EBL group. The pharmacotherapy-EBL group also spent significantly more days in intensive care and a significantly higher percentage of time in the hospital during follow-up than the early-TIPS group. There were no significant differences in serious adverse events between the two groups."In these patients with cirrhosis who were hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS was associated with significant reductions in treatment failure and in mortality," the authors write.The research was funded in part by a grant from Gore, and four study authors disclosed financial ties to Gore and other pharmaceutical and medical device companies.

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