We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Early- TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival.
- Authors
Rudler, M.; Cluzel, P.; Corvec, T. L.; Benosman, H.; Rousseau, G.; Poynard, T.; Thabut, D.
- Abstract
Background Early- TIPSS (transjugular intrahepatic portosystemic shunt) placement may improve rebleeding and reduce 1-year mortality, compared to standard management in high-risk patients with cirrhosis and variceal bleeding. Aim To obtain external validation of this therapeutic approach. Methods We performed a prospective study including all consecutive patients with Child-Pugh C 10-13 cirrhosis or Child-Pugh B with active bleeding at endoscopy admitted to our ICU between March 2011 and February 2013 for variceal bleeding. TIPSS were placed within 72 h after stabilisation. Patients were matched for gender, age, Child-Pugh score, MELD score and to patients from a historical cohort hospitalised before March 2011. Results 31/128 patients with cirrhosis (77.4% men, mean age 53.2 ± 9.0 years old, MELD score 20.9 ± 6.9, Child-Pugh C: 77.4%) admitted for acute variceal bleeding between March 2011 and February 2013 ( TIPSS+ group) were matched to 31 historical patients ( TIPSS− group). Uncontrolled bleeding occurred in 1/31 patients in the TIPSS+ group vs. 2/31 patients in TIPSS− group ( P = 0.55). The 1-year probability of being free of rebleeding was higher in the TIPSS+ group (97% vs. 51%, P < 0.001). Actuarial 1-year survival was not different between the two groups (66.8 ± 9.4% vs. 74.2 ± 7.8%, P = 0.78). Acute cardiac failure occurred more frequently in the TIPSS+ group (25.8% vs. 6.4%, P = 0.03). Conclusions Early- TIPSS placement effectively prevents rebleeding in high-risk patients with variceal bleeding but does not significantly improve survival. This might be due to the high proportion of patients with Child-Pugh C cirrhosis in our series. Cardiac failure may play a role and must be investigated before the procedure, when possible.
- Subjects
RISK-return relationships; HEMORRHAGE; SICK leave; MEDICAL care; THERAPEUTIC complications
- Publication
Alimentary Pharmacology & Therapeutics, 2014, Vol 40, Issue 9, p1074
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.12934