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. 2003 Jan;52(1):130-3.
doi: 10.1136/gut.52.1.130.

Acute propranolol administration effectively decreases portal pressure in patients with TIPS dysfunction. Transjugular intrahepatic portosystemic shunt

L Bellis  1 , E Moitinho, J G Abraldes, M Graupera, J C García-Pagán, J Rodés, J Bosch
Affiliations

Acute propranolol administration effectively decreases portal pressure in patients with TIPS dysfunction. Transjugular intrahepatic portosystemic shunt

L Bellis et al. Gut. 2003 Jan.

Abstract

Background and aims: Up to 60% of patients treated with transjugular intrahepatic portosystemic shunt (TIPS) require angioplasty or restenting during the first year of follow up because of TIPS dysfunction (stenosis of the intrahepatic shunt increasing the portal pressure gradient above the 12 mm Hg threshold). We hypothesised that in patients with TIPS stenosis, propranolol administration, by decreasing portal inflow, would markedly decrease portal pressure.

Patients and methods: Eighteen patients with TIPS dysfunction were investigated by measuring portal pressure gradient before and after acute propranolol administration (0.2 mg/kg intravenously; n=18).

Results: Propranolol markedly reduced the portal pressure gradient (from 16.6 (3.5) to 11.9 (4.8) mm Hg; p<0.0001), cardiac index (-26 (7)%), and heart rate (-18 (7)%) (p<0.0001). Portal pressure gradient decreased to less than 12 mm Hg in nine patients, more frequently in those with moderate dysfunction (portal pressure gradient 16 mm Hg) than in patients with severe dysfunction (portal pressure gradient >16 mm Hg) (8/10 v 1/8; p=0.015).

Conclusions: Propranolol therapy may delay the increase in portal pressure and reduce the need for reintervention in patients with TIPS dysfunction.

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Figures

Figure 1
Figure 1
Individual values for portal pressure gradient (PPG) before and after acute administration of propranolol.
Figure 2
Figure 2
Individual values for portal pressure gradient (PPG) in patients with moderate and severe transjugular intrahepatic portosystemic shunt (TIPS) dysfunction. The number of patients with a decreasing PPG to below 12 mm Hg was significantly greater among those with moderate dysfunction than in those with severe TIPS dysfunction (8/10 v 1/8; p=0.015). This was due to the lower baseline PPG of patients with moderate dysfunction as the absolute fall in PPG was similar in both groups.
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