Early use of TIPS in patients with cirrhosis and variceal bleeding

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 porto - systemic shunt (TIPS). This study...

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Autores: García Pagán, Juan Carlos, Caca, Karel, Bureau, Christophe, Laleman, Wim, Appenrodt, Beate, Luca, Angelo, Abraldes, Juan G., Nevens, Frederick, Vinel, Jean Pierre, Mössner, Joachim, Bosch i Genover, Jaume
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2010
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/47046
Acceso en línea:https://hdl.handle.net/2445/47046
Access Level:acceso abierto
Palabra clave:Cirrosi hepàtica
Hipertensió portal
Assaigs clínics de medicaments
Hepatic cirrhosis
Portal hypertension
Drug testing
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spelling Early use of TIPS in patients with cirrhosis and variceal bleedingGarcía Pagán, Juan CarlosCaca, KarelBureau, ChristopheLaleman, WimAppenrodt, BeateLuca, AngeloAbraldes, Juan G.Nevens, FrederickVinel, Jean PierreMössner, JoachimBosch i Genover, JaumeCirrosi hepàticaHipertensió portalAssaigs clínics de medicamentsHepatic cirrhosisPortal hypertensionDrug testingBackground 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 porto - systemic 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<0.001). Sixteen patients died (12 in the pharmacotherapy-EBL group and 4 in the early-TIPS group, P=0.01). The 1-year actuarial survival was 61% in the pharmacotherapy-EBL group versus 86% in the early-TIPS group (P<0.001). Seven patients in the pharmacotherapy-EBL group received TIPS as rescue therapy, but four died. The number of days in the intensive care unit and the percentage of time in the hospital during follow-up were significantly higher in the pharmacotherapy-EBL group than in the early-TIPS group. No significant diferences were observed between the two treatment groups with respect to serious adverse events. Conclusions In these patients with cirrhosis who were hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS was associated with signif icant reductions in treatment failure and in mortality. (Current Controlled Trials number, ISRCTN58150114.)Massachusetts Medical Society2013201320102013info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion10 p.application/pdfapplication/pdfhttps://hdl.handle.net/2445/47046Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)EspañolReproducció del document publicat a: htt://dx.doi.org/10.1056/NEJMoa0910102New England Journal of Medicine, 2010, vol. 362, num. 25, p. 2370-2379http://dx.doi.org/10.1056/NEJMoa0910102(c) Massachusetts Medical Society, 2010info:eu-repo/semantics/openAccessoai:recercat.cat:2445/470462026-05-29T05:05:01Z
dc.title.none.fl_str_mv Early use of TIPS in patients with cirrhosis and variceal bleeding
title Early use of TIPS in patients with cirrhosis and variceal bleeding
spellingShingle Early use of TIPS in patients with cirrhosis and variceal bleeding
García Pagán, Juan Carlos
Cirrosi hepàtica
Hipertensió portal
Assaigs clínics de medicaments
Hepatic cirrhosis
Portal hypertension
Drug testing
title_short Early use of TIPS in patients with cirrhosis and variceal bleeding
title_full Early use of TIPS in patients with cirrhosis and variceal bleeding
title_fullStr Early use of TIPS in patients with cirrhosis and variceal bleeding
title_full_unstemmed Early use of TIPS in patients with cirrhosis and variceal bleeding
title_sort Early use of TIPS in patients with cirrhosis and variceal bleeding
dc.creator.none.fl_str_mv García Pagán, Juan Carlos
Caca, Karel
Bureau, Christophe
Laleman, Wim
Appenrodt, Beate
Luca, Angelo
Abraldes, Juan G.
Nevens, Frederick
Vinel, Jean Pierre
Mössner, Joachim
Bosch i Genover, Jaume
author García Pagán, Juan Carlos
author_facet García Pagán, Juan Carlos
Caca, Karel
Bureau, Christophe
Laleman, Wim
Appenrodt, Beate
Luca, Angelo
Abraldes, Juan G.
Nevens, Frederick
Vinel, Jean Pierre
Mössner, Joachim
Bosch i Genover, Jaume
author_role author
author2 Caca, Karel
Bureau, Christophe
Laleman, Wim
Appenrodt, Beate
Luca, Angelo
Abraldes, Juan G.
Nevens, Frederick
Vinel, Jean Pierre
Mössner, Joachim
Bosch i Genover, Jaume
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrosi hepàtica
Hipertensió portal
Assaigs clínics de medicaments
Hepatic cirrhosis
Portal hypertension
Drug testing
topic Cirrosi hepàtica
Hipertensió portal
Assaigs clínics de medicaments
Hepatic cirrhosis
Portal hypertension
Drug testing
description 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 porto - systemic 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<0.001). Sixteen patients died (12 in the pharmacotherapy-EBL group and 4 in the early-TIPS group, P=0.01). The 1-year actuarial survival was 61% in the pharmacotherapy-EBL group versus 86% in the early-TIPS group (P<0.001). Seven patients in the pharmacotherapy-EBL group received TIPS as rescue therapy, but four died. The number of days in the intensive care unit and the percentage of time in the hospital during follow-up were significantly higher in the pharmacotherapy-EBL group than in the early-TIPS group. No significant diferences were observed between the two treatment groups with respect to serious adverse events. Conclusions In these patients with cirrhosis who were hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS was associated with signif icant reductions in treatment failure and in mortality. (Current Controlled Trials number, ISRCTN58150114.)
publishDate 2010
dc.date.none.fl_str_mv 2010
2013
2013
2013
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/47046
url https://hdl.handle.net/2445/47046
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
dc.relation.none.fl_str_mv Reproducció del document publicat a: htt://dx.doi.org/10.1056/NEJMoa0910102
New England Journal of Medicine, 2010, vol. 362, num. 25, p. 2370-2379
http://dx.doi.org/10.1056/NEJMoa0910102
dc.rights.none.fl_str_mv (c) Massachusetts Medical Society, 2010
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Massachusetts Medical Society, 2010
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 10 p.
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Massachusetts Medical Society
publisher.none.fl_str_mv Massachusetts Medical Society
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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