"Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding".
Links to original sources: Wiki Journal Post Full Journal Article
The New England Journal of Medicine. 2010. 362:2370-2379. PubMed • Full text • PDF
Contents 1 Clinical Question 2 Bottom Line 3 Major Points 4 Guidelines 5 Design 6 Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7 Interventions 8 Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9 Funding 10 Further Reading
In patients with Child-Pugh class C cirrhosis or class B with persistent endoscopic bleeding, does early use of TIPS with e-PTFE–covered stents improve outcomes compared to standard therapy with vasoactive drugs plus endoscopic therapy?
In patients with cirrhosis and acute variceal bleeding at high risk for treatment failure, early use of TIPS with e-PTFE–covered stents significantly reduces treatment failure and mortality with no increase in risk of hepatic encephalopathy.
The study investigated whether early initiation of TIPS improves outcomes in patients with cirrhosis and variceal bleeding who are at high risk for failure of standard treatment, which consists of vasoactive drugs and endoscopic band ligation. The results showed a significant reduction in rebleeding and mortality rates among patients receiving TIPS.
As of August 2017, guidelines have not been published that reflect the results of this trial.
Multicenter, randomized, controlled trial N=63 patients with cirrhosis and acute variceal bleeding Pharmacotherapy-EBL group (n=31) Early-TIPS group (n=32) Setting: 9 European centers Enrollment: May 2004 to March 2007 Primary follow-up: median 16 months Analysis: Intention-to-treat
Inclusion Criteria Cirrhosis with acute esophageal variceal bleeding treated with vasoactive drugs, endoscopic treatment, and prophylactic antibiotics Child–Pugh class C disease or class B with active bleeding at diagnostic endoscopy Exclusion Criteria Age >75, pregnancy, hepatocellular carcinoma outside Milano criteria, creatinine >3 mg/dL, Child–Pugh score >13, previous portosystemic shunt, bleeding from isolated gastric or ectopic varices, total portal-vein thrombosis, heart failure Baseline Characteristics No significant between-group differences at baseline
Pharmacotherapy-EBL group: continuation of vasoactive-drug therapy followed by propranolol or nadolol and long-term EBL, using TIPS as rescue therapy if needed Early-TIPS group: early use of TIPS within 72 hours with e-PTFE–covered stents
Primary Outcome Failure to control bleeding or prevention of clinically significant variceal rebleeding within 1 year Secondary Outcomes Mortality at 6 weeks and 1 year Development of liver-related complications Number of days in intensive care and percentage of follow-up days spent in hospital Funding Partially funded by grants from multiple institutions including Instituto de Salud Carlos III (Spain), Ministerio de Educación y Ciencia (Spain), University Hospital Center of Toulouse, Fund for Scientific Research — Flanders, and an educational grant from Gore.
Further details are available in the full text of the article at NEJM.org.