Drug-induced QT Prolongation in Cirrhotic Patients With Transjugular Intrahepatic Portosystemic Shunt

Vuppalanchi, Raj; Juluri, Ravi; Ghabril, Marwan; Kim, Seongho; Thong, Nancy; Gorski, J. Christopher; Chalasani, Naga; Hall, Stephen D.

doi:10.1097/mcg.0b013e3181f8c522

Cited by 14 publications

(9 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors found statistically similar baseline QTc intervals (453 ± 8 ms vs. 465 ± 6 ms); however, 1–3 months after TIPS, the QTc interval increased to 484 ± 7 ms ( P = 0.042) and to 480 ± 6 ms ( P = 0.03) at 6–9 months, despite relative preservation in liver synthetic function, plasma electrolytes and haemoglobin concentrations . Similarly, Vuppalanchi et al . described a cohort of eight cirrhotic patients with TIPS and six cirrhotics who had not undergone TIPS and observed that baseline QTc intervals were higher in both the TIPS (418 ms) and non‐TIPS cirrhotics (431 ms) as compared with nine healthy controls.…”

Section: Resultsmentioning

confidence: 88%

“…described a cohort of eight cirrhotic patients with TIPS and six cirrhotics who had not undergone TIPS and observed that baseline QTc intervals were higher in both the TIPS (418 ms) and non‐TIPS cirrhotics (431 ms) as compared with nine healthy controls. After a 7‐day course of erythromycin (a known QTc interval prolonging medicine metabolised by CYP3A), cirrhotics with a TIPS developed a significantly greater prolongation in their QTc interval (180 ± 68 ms) compared with both the cirrhotics without TIPS (31 ± 10 ms) and with the healthy controls (38 ± 3 ms) ( P = 0.03) . These findings should prompt caution when prescribing any medications known to prolong QTc in cirrhotic patients who have undergone a TIPS procedure, especially those patients who are being prescribed a fluoroquinolone for SBP treatment or prophylaxis to best prevent potentially fatal ventricular arrhythmias.…”

Section: Resultsmentioning

confidence: 96%

“…Ofloxacin metabolism is altered by renal dysfunction in patients with ascites, although the penetration of ofloxacin and pefloxacin into ascitic fluid is excellent, achieving therapeutic levels . However, fluroquinolones may prolong QTc intervals in patients who have undergone TIPS and appropriate care should be taken.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Review article: prescribing medications in patients with cirrhosis – a practical guide

Lewis

Stine

2013

Aliment Pharmacol Ther

166

160

View full text Add to dashboard Cite

Summary Background Most drugs have not been well studied in cirrhosis; recommendations on safe use are based largely on experience and/or expert opinion, with dosing recommendations often based on pharmacokinetic (PK) changes. Aim To provide a practical approach to prescribing medications for cirrhotic patients. Methods An indexed MEDLINE search was conducted using keywords cirrhosis, drug‐induced liver injury, pharmacodynamics (PDs), PKs, drug disposition and adverse drug reactions. Unpublished information from the Food and Drug Administration and industry was also reviewed. Results Most medications have not been adequately studied in cirrhosis, and specific prescribing information is often lacking. Lower doses are generally recommended based on PK changes, but data are limited in terms of correlating PD effects with the degree of liver impairment. Very few drugs have been documented to have their hepatotoxicity potential enhanced by cirrhosis; most of these involve antituberculosis or antiretroviral agents used for HIV or viral hepatitis. Paracetamol can be used safely when prescribed in relatively small doses (2–3 g or less/day) for short durations, and is recommended as first‐line treatment of pain. In contrast, NSAIDs should be used cautiously (or not at all) in advanced cirrhosis. Proton pump inhibitors have been linked to an increased risk of spontaneous bacterial peritonitis (SBP) in cirrhosis and should be used with care. Conclusions Most drugs can be used safely in cirrhosis, including those that are potentially hepatotoxic, but lower doses or reduced dosing frequency is often recommended, due to altered PKs. Drugs that can precipitate renal failure, gastrointestinal bleeding, SBP and encephalopathy should be identified and avoided.

show abstract

Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 96%

See 1 more Smart Citation

Review article: prescribing medications in patients with cirrhosis – a practical guide

Lewis

Stine

2013

Aliment Pharmacol Ther

166

160

View full text Add to dashboard Cite

show abstract

“…Cirrhotic patients with transjugular intrahepatic portosystemic shunts are potentially at increased risk for abnormal QT prolongation when exposed to oral CYP 3A substrates with a prolonging effect (e.g. erythromycin) [30]. Similarly, halogenated volatile anesthetics (halothane, enflurane, isoflurane, desflurane, sevoflurane) are among the drugs that cause QTc interval prolongation, and they should therefore be avoided in anesthetic procedures in LQTS and liver cirrhosis patients, due to the increased risk of perioperative malignant ventricular arrhythmias [31].…”

Section: Discussionmentioning

confidence: 99%

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Cichoż‐Lach¹,

Tomaszewski²,

Kowalik³

et al. 2015

Adv Clin Exp Med

View full text Add to dashboard Cite

Background. Liver cirrhosis is associated with functional abnormalities of the cardiovascular system with coexisting electrocardiographic (ECG) abnormalities. Objectives.The aim was to analyze ECG changes in patients with cirrhosis, to evaluate whether alcoholic etiology of cirrhosis and ascites has an impact on ECG changes. Material and Methods. The study involved 81 patients with previously untreated alcoholic cirrhosis (64 patients with ascites, classes B and C according to the Child-Pugh classification; and 17 without ascites, categorized as class A); 41 patients with previously untreated cirrhosis due to chronic hepatitis C (HCV -30 patients with ascites, classes B and C; and 11 without ascites, class A); 42 with alcoholic steatohepatitis and 46 with alcoholic steatosis. The control group consisted of 32 healthy volunteers. Twelve-lead ECG recordings were performed and selected parameters were measured. Results. Significantly longer QT and QTc intervals and lower QRS voltage were found in patients with alcoholic and HCV cirrhosis compared to the controls. Significantly lower QRS voltage was found in subjects with ascites than in those without ascites. Removal of ascites significantly increased QRS voltage. Conclusions. In cirrhosis, irrespective of etiology, ECG changes involved prolonged QT and QTc intervals and reduced QRS voltage. Prolonged QT and QTc intervals were not related to the severity of cirrhosis or to the presence of ascites. However, low QRS voltage was associated with the presence of ascites. Removal of ascites reverses low QRS voltage (Adv Clin Exp Med 2015, 24, 4, 615-622).

show abstract

“…Patients with cirrhosis may suffer from peculiar cardiological dysfunctions, above all when they are in the advanced phases of the liver disease (2)(3)(4)(5). The so-called 'cirrhotic cardiomyopathy' is characterized by blunted contractile stress response, altered diastolic relaxation and electrophysiological abnormalities mainly revealed by QTc prolongation at electrocardiography (ECG) (6)(7)(8)(9). Atrial fibrillation (AF) is the most common heart rhythm disorder in the general population (10)(11)(12)(13).…”

mentioning

confidence: 99%

Atrial fibrillation in patients with cirrhosis

Mwalitsa

Maimone

Filomia

et al. 2015

Liver International

View full text Add to dashboard Cite

show abstract

Drug-induced QT Prolongation in Cirrhotic Patients With Transjugular Intrahepatic Portosystemic Shunt

Abstract: This study suggests that patients with TIPS are potentially at increased risk for abnormal QT prolongation when exposed to oral CYP 3A substrates with QT prolonging effect.

Cited by 14 publications

References 21 publications

Review article: prescribing medications in patients with cirrhosis – a practical guide

Review article: prescribing medications in patients with cirrhosis – a practical guide

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Atrial fibrillation in patients with cirrhosis

Contact Info

Product

Resources

About