Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Prevention of Variceal Rebleeding in Cirrhotic Patients With Portal Vein Thrombosis
Condition: Decompensated Cirrhosis; Portal Vein Thrombosis; Bleeding Varices
MeSH terms: Thrombosis; Venous Thrombosis
Study type: Interventional

Summary: 
      Portal vein thrombosis (PVT) refers to an obstruction in the trunk of the portal vein. It can
      extend downstream to the portal branches, or upstream to the splenic and/or the mesenteric
      veins. The prevalence of PVT is 10-25% and incidence is about 16% in cirrhotic patients.
      Recent studies demonstrate that the presence of PVT is not only an independent predictor of
      failure to control active variceal bleeding and prevent variceal rebleeding, but also
      significantly associated with increased mortality in patients with liver cirrhosis.

      However, in recent American Association of the Study of Liver Disease (AASLD) practice
      guidelines and Baveno V consensus, no treatment strategies in cirrhotic patients with PVT was
      clearly recommended due to the absence of randomized controlled trials.
    

Detailed description: 
      Usually, cirrhotic patients with PVT are submitted to variceal rebleeding prophylaxis with
      endoscopic band ligation combined with non-selective beta-blockers and, when necessary, the
      anticoagulation is started after the varices eradication.

      TIPS is just regarded as the second-line therapy for the secondary prophylaxis of variceal
      bleeding in cirrhotic patients. However, this indication might be changed in the setting of
      PVT. Indeed, the risk to benefit ratio of TIPS in cirrhotic patients with PVT for the
      prevention of recurrent variceal bleeding has never been evaluated.

      The aim of this study is to compare the efficacy and safety of TIPS and endoscopic band
      ligation + propranolol in decompensated cirrhosis patients with PVT and a history of variceal
      bleeding in the past 6 weeks.
    

Intervention name(s): Transjugular intrahepatic portosystemic shunt (TIPS); ET+NSBB
Intervention type(s): Procedure; Procedure
Intervention description(s): Transjugular intrahepatic portosystemic shunt(TIPS)- TIPS was performed in a conventional fashion or in combination of percutaneous transhepatic or transsplenic approach. Postoperatively, intravenous heparin (8,000-12,000 u/d) for five days, warfarin for six months were given.; ET-Esophageal varices was treated by endoscopic variceal ligation (EVL). EVL was repeated at intervals of 1-2 weeks until the varices were obliterated or reduced to grade-I size.
NSBB-Propranolol started at a dose of 20mg twice a day. The dose is adjusted to the maximal tolerated doses to heart rate (HR) of 55 bpm or to decrease the HR 25% from baseline.
AT-A continuously intravenous infusion of unfractionated heparin followed by oral warfarin is employed. Initially, heparin is administered intravenously for 5 days. Subsequently, oral warfarin is prescribed at the dosage of 2.5 mg/d for 6 months or until complete portal vein recanalization and adjusted to maintain the INR at a target of 2.5 (range 2.0-3.0).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment