Early use of TIPS in patients with cirrhosis and variceal bleeding

Juan Carlos García-Pagán, Karel Caca, Christophe Bureau, Wim Laleman, Beate Appenrodt, Angelo Luca, Juan G. Abraldes, Frederik Nevens, Jean Pierre Vinel, Joachim Mössner, Jaime Bosch

Research output: Contribution to journalArticle

Abstract

Background: Patients with cirrhosis in Child-Pugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic portosystemic shunt (TIPS). This study evaluated the earlier use of TIPS in such patients. Methods: We randomly assigned, within 24 hours after admission, a total of 63 patients with cirrhosis and acute variceal bleeding who had been treated with vasoactive drugs plus endoscopic therapy to treatment with a polytetrafluoroethylene-covered stent within 72 hours after randomization (early-TIPS group, 32 patients) or continuation of vasoactive-drug therapy, followed after 3 to 5 days by treatment with propranolol or nadolol and long-term endoscopic band ligation (EBL), with insertion of a TIPS if needed as rescue therapy (pharmacotherapy-EBL group, 31 patients). Results: During a median follow-up of 16 months, rebleeding or failure to control bleeding occurred in 14 patients in the pharmacotherapy-EBL group as compared with 1 patient in the early-TIPS group (P = 0.001). The 1-year actuarial probability of remaining free of this composite end point was 50% in the pharmacotherapy-EBL group versus 97% in the early-TIPS group (P

Original languageEnglish
Pages (from-to)2370-2379
Number of pages10
JournalNew England Journal of Medicine
Volume362
Issue number25
DOIs
Publication statusPublished - Jun 24 2010

ASJC Scopus subject areas

  • Medicine(all)

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    García-Pagán, J. C., Caca, K., Bureau, C., Laleman, W., Appenrodt, B., Luca, A., Abraldes, J. G., Nevens, F., Vinel, J. P., Mössner, J., & Bosch, J. (2010). Early use of TIPS in patients with cirrhosis and variceal bleeding. New England Journal of Medicine, 362(25), 2370-2379. https://doi.org/10.1056/NEJMoa0910102