No value of non‐selective beta‐blockers after TIPS‐insertion
Summary Background and Aims Non‐selective beta‐blockers (NSBB) are a well‐established treatment in patients with clinically significant portal hypertension. However, their potential role after insertion of a transjugular intrahepatic portosystemic shunt (TIPS) still needs to be determined. Of note,...
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| Published in: | Alimentary pharmacology & therapeutics Vol. 60; no. 8; pp. 1021 - 1032 |
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| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Wiley Subscription Services, Inc
01-10-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Summary
Background and Aims
Non‐selective beta‐blockers (NSBB) are a well‐established treatment in patients with clinically significant portal hypertension. However, their potential role after insertion of a transjugular intrahepatic portosystemic shunt (TIPS) still needs to be determined. Of note, recent studies suggested that favourable anti‐inflammatory effects of NSBB might be independent from pressure reduction. This study aimed to evaluate whether NSBB‐treatment is associated with amelioration of systemic inflammation (SI), hepatic decompensation and survival after TIPS‐insertion.
Methods
In a retrospective study comprising 305 consecutive patients, we investigated the impact of NSBB‐intake at TIPS‐placement on periinterventional cirrhosis‐associated complications and continued NSBB‐treatment after discharge on complications including hepatic decompensation and mortality during 1‐year follow‐up, employing multivariable competing‐risk‐analyses. In a prospective cohort including 45 patients, we performed a comprehensive analysis of SI analysing 48 soluble inflammatory markers (SIMs) at baseline plus 3 and 6 months after TIPS‐insertion.
Results
Overall, 175 (57.4%) patients received NSBB‐therapy prior to TIPS‐insertion; upon discharge, this decreased to 131 (22.9%), with 36 (27.5%) discontinuing NSBB within 1‐year follow‐up. Neither NSBB‐therapy at TIPS‐insertion nor treatment‐continuation after discharge were associated with lower risks for hepatic decompensation, individual cirrhosis‐associated complications or mortality neither in the periinterventional period nor during follow‐up. Similarly, in the prospective cohort NSBB‐intake was not linked to lower levels or a more prominent change of WBC, CRP or any other SIM at any of the investigated time points.
Conclusion
NSBB‐therapy at the time of TIPS‐insertion and its (dis‐)continuation afterwards seems to have no significant impact on SI, development of hepatic decompensation and survival.
In this study comprising 305 patients with transjugular intrahepatic portosystemic shunt (TIPS)‐insertion, treatment with non‐selective beta‐blockers (NSBB) after successful portal pressure reduction via TIPS was not associated with lowered risk for hepatic or cardiac decompensation and mortality. Similarly, no impact on systemic inflammation, as measured by WBC, CRP and systemic inflammatory markers (SIM), during follow‐up was found. |
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| Bibliography: | The Handling Editor for this article was Professor Gideon Hirschfield and it was accepted for publication after full peer‐review. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0269-2813 1365-2036 1365-2036 |
| DOI: | 10.1111/apt.18204 |