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Variceal bleeding in patients with cirrhosis is associated with high mortality if not adequately managed. Treatment of acute variceal bleeding with adequate resuscitation maneuvers, restrictive transfusion policy, antibiotic prophylaxis, pharmacologic therapy, and endoscopic therapy is highly effective at controlling bleeding and preventing death. There is a subgroup of high-risk cirrhotic patients in whom this strategy fails, however, and who have a high-mortality rate. Placing a preemptive transjugular intrahepatic portosystemic shunt in these high-risk patients, as soon as possible after admission, to achieve early control of bleeding has proved not only to control bleeding but also to improve survival.
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http://dx.doi.org/10.1016/j.cld.2021.01.001 | DOI Listing |
JHEP Rep
October 2025
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Background & Aims: Conflicting evidence exists on hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B (CHB) receiving tenofovir entecavir. We assessed the impacts of the two drugs on the clinical trajectory of CHB at a population level.
Methods: We conducted a retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database, including 55,885 patients with CHB who were treatment-naïve aged 30-75 years receiving tenofovir (n = 17,137) or entecavir (n = 38,748) monotherapy for ≥3 months between November 2009 and December 2020, and followed until December 2022.
ACG Case Rep J
October 2024
Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY.
Downhill varices, a rare manifestation of venous hypertension, arise from superior vena cava (SVC) obstruction. We present a unique case of downhill varices secondary to SVC syndrome in a 69-year-old man on chronic total parenteral nutrition who presented with large volume melena and facial swelling. In this case, chronic central venous catheter use contributed to thrombotic occlusion of the SVC, leading to collateral vessel formation and variceal development.
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October 2024
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Massive per vaginal bleeding from ectopic pelvic varices is an exceedingly rare presentation in patients with cirrhosis. A 60-year-old postmenopausal woman presented with massive per vaginal (PV) bleeding. Computerized tomography scan showed extensive portosystemic collaterals with a large collateral vessel from the splenic vein to the region of her previous caesarean scar, on a background of liver cirrhosis.
View Article and Find Full Text PDFEmerg Med Australas
October 2025
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Background: Viscoelastic haemostatic assays (VHAs) guide transfusion decisions in bleeding patients. We assessed testing volumes, clinical indications and patient characteristics in a statewide population in Australia.
Methods: This retrospective study included all patients who underwent rotational thromboelastometry (ROTEM) or thromboelastography (TEG) across Queensland Health hospitals (1 January 2019 to 15 April 2025), using data from AUSLAB, the statewide laboratory information system and surveyed all hospitals for VHA device availability.
Am J Med Sci
September 2025
Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Background: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is now the second leading indication for liver transplantation (LT) worldwide and is associated with increased risk of cardiovascular events before and after LT. Cirrhotics who undergo left heart catheterization (LHC) with coronary artery stenting for LT evaluation require dual-antiplatelet therapy (DAPT). Data regarding the safety, risk of gastrointestinal (GI) bleeding, and mortality risk of cirrhotics receiving DAPT is limited.
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