Nonselective β-Blockers May Progress the Thrombosis of Portal Venous System in Cirrhotic Patients: A Retrospective Observational Study

Xu, Xiangbo; Xu, Shixue; Primignani, Massimo; Stefano, Valerio De; He, Yanglan; Yi, Fang; Guo, Xiaozhong; Valla, Dominique; Qi, Xingshun

doi:10.1007/s12325-020-01250-z

Cited by 16 publications

(15 citation statements)

References 32 publications

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“…Compensated cirrhosis is associated with a higher portal vein recanalization rate; by comparison, patients with Child-Pugh class B and C and higher MELD score have a lower portal vein recanalization rate. Advanced liver cirrhosis has an aggravation of portal hypertension and a higher probability of using non-selective beta-blockers, thereby reducing the portal vein blood flow velocity which may contribute to the development and progression of PVT [ 55 , 56 ]. In addition, patients with advanced cirrhosis are more prone to the risk of thrombotic events and resistance to anticoagulation [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis

Wang

Guo

et al. 2020

Adv Ther

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Introduction: Benefit and risk of anticoagulation in cirrhotic patients with portal vein thrombosis (PVT) remain controversial, especially in those with asymptomatic PVT and in non-liver transplant candidates. Furthermore, the predictors of portal vein recanalization and bleeding events after anticoagulation are critical for making clinical decisions, but still unclear. We conducted a meta-analysis to investigate the outcomes of anticoagulation for PVT in liver cirrhosis and explore the predictors of portal vein recanalization and bleeding events after anticoagulation. Methods: All studies regarding anticoagulation for PVT in liver cirrhosis were searched via PubMed, EMBASE, and Cochrane Library databases. Thrombotic outcomes, bleeding events, and survival were compared between anticoagulation and non-anticoagulation groups. Predictors of portal vein recanalization and bleeding events were pooled. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Thirty-three studies including 1696 cirrhotic patients with PVT were included. Anticoagulation significantly increased portal Electronic supplementary material The online version of this article (

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Section: Discussionmentioning

confidence: 99%

Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis

Wang

Guo

et al. 2020

Adv Ther

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“… 32 A retrospective study also proved that NSBB was significantly associated with PVT progression (OR = 4.400, 95% CI: 1.107–17.482, p = 0.035). 33 Besides, a meta-analysis demonstrated that use of NSBB progressed PVT (OR = 4.62, 95% CI: 2.50–8.53, p < 0.00001) and subgroup meta-analyses also manifested a consistent association between NSBB and PVT in both cohort studies (RR = 2.57, 95% CI: 1.46–4.51, p = 0.001) and case–control studies (OR = 8.17, 95% CI: 2.46–27.06, p = 0.0006). 34 Therefore, increased risk of PVT development brought by NSBB application might put management of variceal bleeding complicated with PVT into jeopardy.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of myeloproliferative neoplasm-associated portal hypertension and endoscopic management of variceal bleeding

Huang

Zhang

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Myeloproliferative neoplasms (MPNs) are a rare yet important clinical cause of portal hypertension, which may cause recurrent gastroesophageal variceal bleeding (GVB). MPN-associated variceal bleeding lacks specific guidelines and clinical consensus and desiderates cohort studies. We performed a multicenter retrospective study to investigate the efficacy of endoscopic management of bleeding in MPNs. Methods: We included consecutive MPN patients with gastroesophageal varices in eight tertiary university hospitals between January 2007 and March 2020. The clinical characteristics of participants were summarized. MPN patients with a history of GVB were followed up for the rebleeding and death, compared with controls suffering from schistosomiasis-associated portal hypertension who received endoscopic treatment for variceal bleeding at the same period. Results: A total of 62 MPN patients with gastroesophageal varices were identified, and 37 had a history of GVB. Of these, 24 patients received endoscopic variceal ligation and endoscopic injection of cyanoacrylate for the prophylaxis of variceal rebleeding. Endoscopic treatment significantly reduced the rebleeding rate in MPN patients with a history of GVB (28.2% versus 68.3%, p = 0.0269). Multivariable Cox regression indicated that endoscopic treatment (HR = 0.10, 95% CI: 0.02–0.54, p = 0.008) was the independent protective factor for decreasing the 3-year rebleeding rate, while the use of non-selective beta-blockers (NSBB) (HR = 13.41, 95% CI: 2.15–83.42, p = 0.005) was the risk factor for increasing the 3-year rebleeding rate. As for the efficacy of endoscopic management, 3-year rebleeding rate was significantly lower in MPN patients in contrast to 46 controls with schistosomiasis-associated variceal bleeding (32.9% versus 59.0%, p = 0.0346). Conclusion: Endoscopic treatment might be a feasible and potent approach in the management of gastroesophageal variceal rebleeding in MPNs, while NSBB might be ineffective.

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“…Although NSBBs play an important role in the prevention of variceal rebleeding, there are still a series of problems, such as NSBB-related side effects and the use of NSBBs in cirrhotic patients with spontaneous bacterial peritonitis, and refractory ascites is still controversial [ 25 ]. In addition, studies have shown that the use of NSBBs is a risk factor for portal vein thrombosis [ 26 – 28 ]. In our study, two patients who took propranolol decreased from 80 mg/d to 60 mg/d due to decreased heart rate, and no obvious adverse reactions were found in other patients.…”

Section: Discussionmentioning

confidence: 99%

Increase in Free Hepatic Venous Pressure Response to Beta-Blockers Predicts Variceal Bleeding in Cirrhotic Patients

Guo

Xiao

Wang

et al. 2021

BioMed Research International

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Background and Aims. Nonselective beta-blockers (NSBBs) are the main drug to prevent portal hypertension. It could alter free hepatic venous pressure (FHVP); however, the significance is unknown. This prospective study was to explore the change of FHVP after use of NSBBs and its predictive value for gastroesophageal varices (GOV) bleeding in cirrhotic patients. Patients and Methods. Cirrhotic patients with medium-large GOV between September 2014 and January 2019 were enrolled. After initial hepatic venous pressure gradient (HVPG) measurement, patients received oral NSBBs. Seven days later, the secondary HVPG was examined to evaluate the FHVP alteration and hemodynamic response. The variceal bleeding between patients with FHVP increased and decreased/unchanged was compared. Results. A total of 74 patients were enrolled, and 62 patients completed the secondary HVPG measurement and was followed up. The cumulative bleeding rate was significantly higher in patients with FHVP increased ≥ 1.75 mmHg than those with FHVP decreased/unchanged (54.5% vs. 22.5%, p = 0.021 ), while there was no significant difference in bleeding between HVPG responders and nonresponders (32.6% vs. 37.5%, p = 0.520 ). For HVPG responders, variceal bleeding in patients with FHVP increased ≥ 1.75 mmHg was significantly more than that in patients with FHVP decreased/unchanged (57.9% vs. 28.6%, p = 0.041 ). Cox regression analysis showed that change of FHVP was an independent predictor of variceal bleeding. Conclusion. Increase ≥ 1.75 mmHg in FHVP responding to beta-blockers in cirrhotic patients with GOV indicates high risk of variceal bleeding. Besides HVPG response, change of FHVP should also be valued in hemodynamic evaluation to beta-blockers. This trial is registered with Chinese Clinical Trial Registry ChiCTR-IPR-17012836.

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Nonselective β-Blockers May Progress the Thrombosis of Portal Venous System in Cirrhotic Patients: A Retrospective Observational Study

Cited by 16 publications

References 32 publications

Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis

Anticoagulation Favors Thrombus Recanalization and Survival in Patients With Liver Cirrhosis and Portal Vein Thrombosis: Results of a Meta-Analysis

Characteristics of myeloproliferative neoplasm-associated portal hypertension and endoscopic management of variceal bleeding

Increase in Free Hepatic Venous Pressure Response to Beta-Blockers Predicts Variceal Bleeding in Cirrhotic Patients

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