Beta‐blockers in 2016: Still the safest and most useful drugs for portal hypertension?

D’Amico, Gennaro; Malizia, Giuseppe; Bosch, Jaime

doi:10.1002/hep.28502

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Ultimately, more mechanistic studies are needed to identify biomarkers in patients with decompensated liver disease that indicate beneficial effects of NSBBs and situations where NSBBs might be harmful. An increasing body of evidence suggests, that there is no detrimental effect of NSBBs in patients with ascites in general [32][33][34]. However, the use of NSBBs should be based on a critical risk/ benefit evaluation in patients with refractory ascites and signs of systemic circulatory dysfunction [16,35].…”

Section: Diagnostic and Prognostic Biomarkersmentioning

confidence: 99%

Beta adrenergic blockade and decompensated cirrhosis

Reiberger

Mandorfer

2017

Journal of Hepatology

130

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Section: Diagnostic and Prognostic Biomarkersmentioning

confidence: 99%

Beta adrenergic blockade and decompensated cirrhosis

Reiberger

Mandorfer

2017

Journal of Hepatology

130

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“…While beta-blockers continue to occupy a pivotal role in the treatment of portal hypertension, recent evidence has not only outlined additional, haemodynamically-independent beneficial effects of beta-blockers in cirrhosis, but also described potentially debilitating effects in advanced cirrhotics. Concerning clinical practice, D’Amico et al[46] recommend that beta-blocker therapy should: (1) Not be used in compensated cirrhotics with no evidence of varices; (2) be used in cirrhotic patients with varices at risk of bleeding or re-bleeding independent of the absence/presence of ascites; and (3) be used with caution in cirrhotic patients with refractory ascites and discontinued if haemodynamic or renal compromise arises. Currently, the Braveno VI consensus and 2017 AASLD guidelines recommend temporarily reducing or withholding beta-blockers in patients with refractory ascites and circulatory dysfunction (serum sodium < 130 mEq/L, systolic BP < 90 mmHg)[5,47,48].…”

Section: Currently-used Medicationsmentioning

confidence: 99%

Current and future pharmacological therapies for managing cirrhosis and its complications

Kockerling

Nathwani

Forlano

et al. 2019

WJG

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Due to the restrictions of liver transplantation, complication-guided pharmacological therapy has become the mainstay of long-term management of cirrhosis. This article aims to provide a complete overview of pharmacotherapy options that may be commenced in the outpatient setting which are available for managing cirrhosis and its complications, together with discussion of current controversies and potential future directions. PubMed/Medline/Cochrane Library were electronically searched up to December 2018 to identify studies evaluating safety, efficacy and therapeutic mechanisms of pharmacological agents in cirrhotic adults and animal models of cirrhosis. Non-selective beta-blockers effectively reduce variceal re-bleeding risk in cirrhotic patients with moderate/large varices, but appear ineffective for primary prevention of variceal development and may compromise renal function and haemodynamic stability in advanced decompensation. Recent observational studies suggest protective, haemodynamically-independent effects of beta-blockers relating to reduced bacterial translocation. The gut-selective antibiotic rifaximin is effective for secondary prophylaxis of hepatic encephalopathy; recent small trials also indicate its potential superiority to norfloxacin for secondary prevention of spontaneous bacterial peritonitis. Diuretics remain the mainstay of uncomplicated ascites treatment, and early trials suggest alpha-adrenergic receptor agonists may improve diuretic response in refractory ascites. Vaptans have not demonstrated clinical effectiveness in treating refractory ascites and may cause detrimental complications. Despite initial hepatotoxicity concerns, safety of statin administration has been demonstrated in compensated cirrhosis. Furthermore, statins are suggested to have protective effects upon fibrosis progression, decompensation and mortality. Evidence as to whether proton pump inhibitors cause gut-liver-brain axis dysfunction is conflicting. Emerging evidence indicates that anticoagulation therapy reduces incidence and increases recanalisation rates of non-malignant portal vein thrombosis, and may impede hepatic fibrogenesis and decompensation. Pharmacotherapy for cirrhosis should be implemented in accordance with up-to-date guidelines and in conjunction with aetiology management, nutritional optimisation and patient education.

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“…Statins are recommended, and there are data to suggest they may also be beneficial in lowering portal pressure independent of their CV benefits . β‐blocking agents are standard treatments for the secondary prevention of CV events, and although their use in the general perioperative setting and more recently in ESLD has been controversial, there is evidence to suggest that they reduce the incidence of CV events after LT …”

Section: Treating Coronary Artery Disease In Liver Transplant Candidatesmentioning

confidence: 99%

Evaluation of coronary artery disease in potential liver transplant recipients

2017

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Improvements in the management of patients undergoing liver transplantation (LT) have resulted in a significant increase in survival in recent years. Cardiac disease is now the leading cause of early mortality, and the stress of major surgery, hemodynamic shifts, and the possibilities of hemorrhage or reperfusion syndrome require the recipient to have good baseline cardiac function. The prevalence of coronary artery disease (CAD) is increasing in LT candidates, especially in those with nonalcoholic fatty liver disease. In assessing LT recipients, we suggest a management paradigm of "quadruple assessment" to include (1) history, examination, and electrocardiogram; (2) transthoracic echocardiogram; (3) functional testing; and (4) where appropriate, direct assessment of CAD. The added value of functional testing, such as cardiopulmonary exercise testing, has been shown to be able to predict posttransplant complications independently of the presence of CV disease. This approach gives the assessment team the greatest chance of detecting and preventing complications related to CAD. Liver Transplantation 23 386-395 2017 AASLD.

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Beta‐blockers in 2016: Still the safest and most useful drugs for portal hypertension?

Cited by 11 publications

References 10 publications

Beta adrenergic blockade and decompensated cirrhosis

Beta adrenergic blockade and decompensated cirrhosis

Current and future pharmacological therapies for managing cirrhosis and its complications

Evaluation of coronary artery disease in potential liver transplant recipients

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