Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

Several clinical variables, potentially treatable, may alter particular aspects of HRQOL. Correction of ascites, hypoalbuminemia, minimal hepatic encephalopathy, and anemia may cause a positive impact on HRQOL of patients with cirrhosis.

Branched-chain amino acids for people with hepatic encephalopathy.

Supplements with branched-chain amino acid (BCAA) have cerebral, metabolic, and nutritional effects that may benefit patients with hepatic encephalopathy (HE). We therefore conducted a systematic review on the effects of oral BCAAs compared with control supplements or placebo for patients with cirrhosis and recurrent overt or minimal HE. The quantitative analyses included data from 8 trials (n = 382 patients). Individual patient data were retrieved from 4 trials to recalculate outcomes (n = 255 patients). The mean dose of the oral BCAA supplements was 0.25 g/(kg body weight · d). Random effects meta-analysis showed that improvements in HE manifestations were registered for 87 of 172 patients in the BCAA group compared with 56 of 210 controls [risk ratio = 1.71 (95% CI: 1.17, 2.51) number needed to treat = 5 patients]. The effect of BCAAs differed (P = 0.04) for patients with overt [risk ratio = 3.26 (95% CI: 1.47, 7.22)] and minimal HE [risk ratio = 1.32 (95% CI: 0.97, 1.79)]. Subgroup, sensitivity, regression, and sequential analyses found no other sources of heterogeneity or bias. BCAA supplements had no effect on mortality or markers of nutritional status and did not induce adverse events. In conclusion, oral BCAA supplements improve manifestations of HE but have no effect on survival.

Branched-chain amino acids for people with hepatic encephalopathy (Review)

BACKGROUND Hepatic encephalopathy is presented clinically as a combination of neuropsychiatric abnormalities. It is frequently observed in those with both acute and chronic liver diseases, such as hepatic cirrhosis, alcoholic liver disease. Insufficient hepatic clearance of toxins absorbed from the intestine, can result in neurochemical abnormalities across the blood brain barrier. Presently, non-absorbable disaccharides like Lactulose and antibiotics like Rifaximin are the mainstay of therapy. In cirrhosis of liver there is severe catabolic state, and consequent degradation of body protein is the major determinant of the characteristic amino acid imbalance with increased aromatic amino acid and decreased branched chain amino acid. So branched chain amino-acids could be effective in the treatment of hepatic encephalopathy. The aim of the study is to compare the efficacy of treatment of group who take Rifaximin, and Lactulose (group A) with the group taking Rifaximin, Lactulose and Branched Chain Amino-Acids (Group B) in Grade 1 to Grade 3 of hepatic encephalopathy.

Branched-chain amino acids for people with hepatic encephalopathy.

Antithrombotic drugs are the therapeutic cornerstone for patients with antiphospholipid syndrome (APS) and thrombosis. Choosing the specific agent (vitamin K antagonists or antiplatelet drugs), the intensity of anticoagulation (e.g., international normalized ratio [INR] range 2.0 to 3.0 or 3.0 to 4.0), and the duration of treatment has been a recurrent matter of debate. A recent consensus document recommends warfarin to an INR range of 2.0 to 3.0 for patients with a first venous thromboembolic event. Higher anticoagulation intensity is recommended for patients presenting with arterial events. Combined therapy with warfarin and aspirin is another possibility, but some authors recommend standard intensity warfarin or aspirin, either as monotherapy. In general, a more intense regimen is warranted for high-risk patients. On the basis of an increased risk of recurrence during the first 6 months following warfarin withdrawal, long-term anticoagulation is considered the standard treatment. Nevertheless, anticoagulation regimes of shorter duration could be given in selected patients with venous thromboembolism who have transient risk factors and a low-risk profile.