Gastroesophageal Variceal Hemorrhage

Sharara, Ala I.; Rockey, Don C.

doi:10.1056/nejmra003007

Cited by 355 publications

(225 citation statements)

References 105 publications

Supporting

Mentioning

195

Contrasting

Unclassified

Order By: Relevance

“…Patients with variceal bleeding can be managed with either pharmacologic or endoscopic therapy to prevent rebleeding. However, 20-30% of patients will rebleed despite these therapies leading to variceal decompression as the only effective alternative (4,5).…”

Section: Introductionmentioning

confidence: 99%

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Boyer

Henderson

Heerey

et al. 2008

Journal of Hepatology

View full text Add to dashboard Cite

Background and aims-We examined the cost and cost effectiveness of distal splenorenal shunt (DSRS) and transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of variceal rebleeding. Subjects-Participants in randomized controlled trial comparing DSRS to TIPS.Methods-Quality of life (QOL) measured using SF-36 preceding randomization and yearly thereafter. Cost utility analysis was performed using Data Treeage ®. Costs for both in-and outpatient events and interventions were obtained for each patient. Costs using coated stents were estimated using different rates of stenosis. Incremental cost effectiveness ratios (ICERs) were determined at 1, 3 and 5 years.Results-The average yearly costs of managing patients after TIPS and DSRS over 5 years were similar, $16,363 and $13,492 respectively. Cost of TIPS for surviving patients exceeded the cost of DSRS at years 3 and 5 but not significantly. ICERs per life saved favored TIPS at year 5 ($61,000). If coated rather than bare stents were used the cost-effectiveness of TIPS increased slightly.Conclusions-TIPS is as effective as DSRS in preventing variceal rebleeding and may be more cost effective. TIPS, in all aspects, is equal to DSRS in the prevention of variceal rebleeding in patients who are medical failures.

show abstract

Section: Introductionmentioning

confidence: 99%

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Boyer

Henderson

Heerey

et al. 2008

Journal of Hepatology

View full text Add to dashboard Cite

show abstract

“…2,[10][11][12][13] Such treatments are effective in bleeding control, but require expertise and are associated with complications and high mortality, particularly in patients with poor liver function. [14][15][16][17][18] In patients with cirrhosis, compromised hepatic function results in decreased synthesis of coagulation factors, notably factor VII (FVII). 19 Coagulopathy may therefore be associated with failure to control variceal bleeding and promotion of rebleeding, 8,[20][21][22] and patients might thus benefit from a drug that could correct the coagulopathy and restore hemostasis.…”

mentioning

confidence: 99%

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

et al. 2008

View full text Add to dashboard Cite

on behalf of the International Study Group on rFVIIa in UGI Hemorrhage A beneficial effect of recombinant activated factor VII (rFVIIa) in Child-Pugh class B and C patients with cirrhosis who have variceal bleeding has been suggested. This randomized controlled trial assessed the efficacy and safety of rFVIIa in patients with advanced cirrhosis and active variceal bleeding. At 31 hospitals in an emergency setting, 256 patients (Child-Pugh > 8; Child-Pugh B ‫؍‬ 26%, C ‫؍‬ 74%) were randomized equally to: placebo; 600 g/kg rFVIIa (200 ؉ 4؋ 100 g/kg); or 300 g/kg rFVIIa (200 ؉ 100 g/kg). Dosing was intravenous at 0, 2, 8, 14, and 20 hours after endoscopy, in addition to standard vasoactive, prophylactic antibiotic, and endoscopic treatment. The primary composite endpoint consisted of failure to control 24-hour bleeding, or failure to prevent rebleeding or death at day 5. Secondary endpoints included adverse events and 42-day mortality. Baseline characteristics were comparable between groups. Administration of rFVIIa had no significant effect on the composite endpoint compared with placebo (P ‫؍‬ 0.37). There was no significant difference in 5-day mortality between groups; however, 42-day mortality was significantly lower with 600 g/kg rFVIIa compared with placebo (odds ratio 0.31, 95% confidence interval ‫؍‬ 0.13-0.74), and bleeding-related deaths were reduced from 12% (placebo) to 2% (600 g/kg). A marked heterogeneity in the failure rate in all treatment groups was observed across participating centers. Adverse events, including overall thromboembolic events, were comparable between groups. Conclusion: Treatment with rFVIIa had no significant effect on the primary composite endpoint compared with placebo. Therefore, decision on the use of this hemostatic agent in acute variceal bleeding should be carefully considered, because results of this study do not support the routine use of rFVIIa in this setting. Adverse events were comparable across groups. (HEPATOLOGY 2008;47:1604-1614

show abstract

“…El porcentaje de pacientes portadores de várices que sangran en un momento dado en nuestro medio es de 55%, (30 al 70%) referido en la literatura 1 -4 . El porcentaje de resangrado llega a ser de 67,7, (30-40%) en la literatura 4 .…”

Section: Discussionunclassified

“…Hasta 30% de las personas con cirrosis desarrollan várices 1 , entre 30% y 70% de estas sufren de una o más rupturas en el tiempo 2 , ocasionando hemorragias con mortalidad de hasta 30% para el primer episodio, y en aumento en los siguientes episodios 3 . La tasa de resangrado puede alcanzar de 30 al 40% en las primeras seis semanas 4 , y está signifi cativamente relacionada con la mortalidad en este período 5 .…”

unclassified

Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas

Ríos¹,

Sierralta²,

Abarzúa³

et al. 2012

Rev. méd. Chile

View full text Add to dashboard Cite

Gastroesophageal Variceal Hemorrhage

Cited by 355 publications

References 105 publications

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Cost of preventing variceal rebleeding with transjugular intrahepatic portal systemic shunt and distal splenorenal shunt

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

Comparación de la efectividad de la ligadura vs esclerosis endoscópica en pacientes con sangrado de várices esofágicas en el Hospital Hernán Henríquez de Temuco: estudio de cohortes comparativas

Contact Info

Product

Resources

About