Treatment of Hepatic Encephalopathy in Liver Cirrhosis with Prior Overt Episodes Before TIPS Placement

Patients with liver cirrhosis who have experienced previous episodes of overt hepatic encephalopathy face an elevated risk of further neurological deterioration, particularly when undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement. This protocol addresses the specific management of this high-risk scenario in the non-urgent setting.

Clinical Scenario

Liver cirrhosis with a documented history of previous overt hepatic encephalopathy episodes, in a patient scheduled for non-urgent TIPS placement. The procedural context elevates the near-term risk of overt HE and warrants a targeted prophylactic approach prior to the intervention.

Prophylaxis Approach

In this setting, rifaximin can be considered as the basis of a structured prophylaxis regimen initiated in the weeks before the procedure. The specific timing and duration of therapy are defined in the full protocol.

Full dosing schedule, duration, and any adjunctive considerations are available in the complete evidence-based regimen below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2022.06.001

In patients with cirrhosis and previous episodes of overt HE, rifaximin can be considered for prophylaxis of HE prior to non-urgent TIPS placement.

In patients with cirrhosis and previous episodes of overt HE, rifaximin can be considered for prophylaxis of HE prior to non-urgent TIPS placement. Non-absorbable disaccharides, as a stand-alone or in combination, are worthy of further study in this context (LoE 2, strong recommendation, 82% consensus).

In this trial, rifaximin was started 14 days prior to TIPS placement and continued for approximately 6 months.

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