Early-TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival

Aliment Pharmacol Ther. 2014 Nov;40(9):1074-80. doi: 10.1111/apt.12934. Epub 2014 Sep 17.


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.

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / prevention & control
  • Hemorrhage / etiology
  • Hemorrhage / mortality*
  • Hemorrhage / prevention & control*
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / mortality*
  • Liver Cirrhosis / surgery*
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic / adverse effects
  • Portasystemic Shunt, Transjugular Intrahepatic / methods*
  • Portasystemic Shunt, Transjugular Intrahepatic / mortality*
  • Prospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors