Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites: a retrospective multicentre cohort study

Seifert, Leon Louis; Schindler, Philipp; Sturm, Lukas; Gu, Wenyi; Seifert, Quentin Edward; Weller, Jan Frederic; Jansen, Christian; Praktiknjo, Michael; Meyer, Carsten H.; Schoster, Martin; Wilms, Christian; Maschmeier, Miriam; Schmidt, Hartmut; Masthoff, Max; Köhler, Michael; Schultheiß, Michael; Huber, Jan Patrick; Bettinger, Dominik; Trebicka, Jonel; Wildgruber, Moritz; Heinzow, Hauke

doi:10.1007/s12072-022-10330-x

Cited by 9 publications

(3 citation statements)

References 34 publications

(35 reference statements)

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“…The decision for anticoagulation further depends on the underlying disease, with BCS or PVT certainly requiring anticoagulation [23]. A recent retrospective multicenter study showed a potential survival benefit for acetylsalicylic acid after TIPS in adults [24], although this opinion is not without detractors [25]. In children, there is no consensus, and the primary indication for TIPS may guide anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Children with Transjugular Intrahepatic Portosystemic Shunt: A Meta-Analysis of Individual Patient Data

Deniz

Schinner

Monroe

et al. 2023

Cardiovasc Intervent Radiol

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Purpose The purpose of the study was to investigate outcome after pediatric transjugular intrahepatic portosystemic shunt (TIPS) with respect to survival Material and Methods After searching for studies on TIPS in children in Ovid, Medline, Embase, Scopus and Cochrane published between 2000 and 2022, individual patient data were retrieved from five retrospective cohorts. Overall survival (OS) and transplant-free survival (TFS) were calculated using Kaplan–Meier analysis and log-rank test and compared to the indication (ascites vs. variceal bleeding) as well as to the level of obstruction (pre-hepatic vs. hepatic vs. post-hepatic). Additionally, TIPS patency was analyzed. Results n = 135 pediatric patients were included in the final analysis. Indication for pediatric TIPS creation was heterogeneous among the included studies. TIPS patency decreased from 6 to 24 months, subsequent pediatric liver transplantation was performed in 22/135 (16.3%) of cases. The presence of ascites was related with poorer TFS (HR 2.3, p = 0.023), while variceal bleeding was not associated with impaired survival. Analysis of the level of obstruction (pre-hepatic, hepatic and post-hepatic) failed to prove significantly reduced OS for post-hepatic obstruction (HR 3.2, p = 0.092) and TFS (HR 1.3, p = 0.057). There was no difference in OS and TFS according to age at time of TIPS placement. Conclusions The presence of ascites associates with impaired survival after TIPS in children, with no differences in survival according to the age of the child. Interventional shunt procedures can be considered feasible for all ages. Level of Evidence Level 2a. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Outcome of Children with Transjugular Intrahepatic Portosystemic Shunt: A Meta-Analysis of Individual Patient Data

Deniz

Schinner

Monroe

et al. 2023

Cardiovasc Intervent Radiol

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“…The necessity of anticoagulation or antiplatelet therapy after TIPS procedure remains controversial. There are studies which could demonstrate a beneficial effect of the administration of aspirin in terms of post-TIPS survival [59]. Nevertheless, with the occurrence of polytetrafluoroethylene (PTFE)-covered stents, the general rate of shunt dysfunction was observed to be lower [60, 61].…”

Section: Indications and Practical Managementmentioning

confidence: 99%

The Challenge of Anticoagulation in Liver Cirrhosis

Eichholz,

Wedemeyer,

Maasoumy

2023

Visc Med

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Background: Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient. Summary: The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort. Key Message: The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.

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“…We would like to thank Dr. Wang, Dr. Qi and their team for their interest and appreciate the raised issues regarding our study entitled ‘Aspirin improves transplant-free survival after TIPS implantation in patients with refractory ascites—a retrospective multicenter cohort study’ [ 1 ].…”

Section: To the Editormentioning

confidence: 99%