Preventing Rebleeding in Liver Cirrhosis After Prior Variceal Haemorrhage
Clinical Scenario
Patients with liver cirrhosis who have experienced a variceal haemorrhage carry a high risk of recurrent bleeding. Once the acute event is controlled, the clinical priority shifts to secondary prophylaxis — a structured approach to preventing further haemorrhage.
Evidence-based combination therapy is the recommended standard for rebleeding prevention, demonstrating superiority over monotherapy approaches.
Treatment Approach
When first-line management cannot be sustained due to intolerance, covered TIPS placement is a guideline-recommended option in appropriately selected patients. Full eligibility criteria, contraindications, and the complete management sequence are available in the structured regimen.
References
DOI: 10.1016/j.jhep.2018.03.024
- Combination therapy of NSBBs + EBL is recommended since it reduces the risk of rebleeding compared with monotherapy (I,1).
- If the patient continues to be intolerant to NSBB, covered TIPS placement is recommended provided that there are no absolute contraindication (cf. criteria in ascites section) (III,1).
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