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

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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

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Transjugular Intrahepatic Portasystemic Shunt
Fibrosis
Hemorrhage
Ligation
Drug Therapy
Nadolol
Therapeutics
Polytetrafluoroethylene
Random Allocation
Treatment Failure
Propranolol
Endoscopy
Stents

ASJC Scopus subject areas

  • Medicine(all)

Cite this

García-Pagán, J. C., Caca, K., Bureau, C., Laleman, W., Appenrodt, B., Luca, A., ... 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

Early use of TIPS in patients with cirrhosis and variceal bleeding. / García-Pagán, Juan Carlos; Caca, Karel; Bureau, Christophe; Laleman, Wim; Appenrodt, Beate; Luca, Angelo; Abraldes, Juan G.; Nevens, Frederik; Vinel, Jean Pierre; Mössner, Joachim; Bosch, Jaime.

In: New England Journal of Medicine, Vol. 362, No. 25, 24.06.2010, p. 2370-2379.

Research output: Contribution to journalArticle

García-Pagán, JC, Caca, K, Bureau, C, Laleman, W, Appenrodt, B, Luca, A, Abraldes, JG, Nevens, F, Vinel, JP, Mössner, J & Bosch, J 2010, 'Early use of TIPS in patients with cirrhosis and variceal bleeding', New England Journal of Medicine, vol. 362, no. 25, pp. 2370-2379. https://doi.org/10.1056/NEJMoa0910102
García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. New England Journal of Medicine. 2010 Jun 24;362(25):2370-2379. https://doi.org/10.1056/NEJMoa0910102
García-Pagán, Juan Carlos ; Caca, Karel ; Bureau, Christophe ; Laleman, Wim ; Appenrodt, Beate ; Luca, Angelo ; Abraldes, Juan G. ; Nevens, Frederik ; Vinel, Jean Pierre ; Mössner, Joachim ; Bosch, Jaime. / Early use of TIPS in patients with cirrhosis and variceal bleeding. In: New England Journal of Medicine. 2010 ; Vol. 362, No. 25. pp. 2370-2379.
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AU - Luca, Angelo

AU - Abraldes, Juan G.

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