RT Journal Article
T1 Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study.
A1 Hernández-Gea, Virginia
A1 Procopet, Bogdan
A1 Giráldez, Álvaro
A1 Amitrano, Lucio
A1 Villanueva, Candid
A1 Thabut, Dominique
A1 Ibañez-Samaniego, Luis
A1 Silva-Junior, Gilberto
A1 Martinez, Javier
A1 Genescà, Joan
A1 Bureau, Christophe
A1 Trebicka, Jonel
A1 Llop, Elba
A1 Laleman, Wim
A1 Palazon, Jose Maria
A1 Castellote, Jose
A1 Rodrigues, Susana
A1 Gluud, Lise L
A1 Noronha Ferreira, Carlos
A1 Barcelo, Rafael
A1 Cañete, Nuria
A1 Rodríguez, Manuel
A1 Ferlitsch, Arnulf
A1 Mundi, Jose Luis
A1 Gronbaek, Henning
A1 Hernández-Guerra, Manuel
A1 Sassatelli, Romano
A1 Dell'Era, Alessandra
A1 Senzolo, Marco
A1 Abraldes, Juan G
A1 Romero-Gómez, Manuel
A1 Zipprich, Alexander
A1 Casas, Meritxell
A1 Masnou, Helena
A1 Primignani, Massimo
A1 Krag, Aleksander
A1 Nevens, Frederik
A1 Calleja, Jose Luis
A1 Jansen, Christian
A1 Robic, Marie Angèle
A1 Conejo, Irene
A1 Catalina, Maria-Vega
A1 Albillos, Agustin
A1 Rudler, Marika
A1 Alvarado, Edilmar
A1 Guardascione, Maria Anna
A1 Tantau, Marcel
A1 Bosch, Jaime
A1 Torres, Ferran
A1 Garcia-Pagán, Juan Carlos
A1 International Variceal Bleeding Observational Study Group and Baveno Cooperation, 
AB Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.
YR 2018
FD 2018-12-10
LK http://hdl.handle.net/10668/12716
UL http://hdl.handle.net/10668/12716
LA en
DS RISalud
RD Apr 19, 2025