Christian J Steib1, Hanwei Li1, Jiang Zhang1, Julia Mayerle1, Jens Ricke2, Alexander L Gerbes1, Carsten Meyer3, Alexander Zipprich4, Jonel Trebicka5. 1. Departments of Medicine II. 2. Radiology, University Hospital, Liver Centre Munich, LMU Munich, Munich. 3. Department of Radiology, University Hospital Bonn, Bonn. 4. Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle. 5. Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany.
Abstract
OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) insertion is an established treatment to lower portal pressure. There are no obligatory evidence-based recommendations addressing procedure and anticoagulation. Therefore, a survey was performed to establish current practice at different German hospitals. METHODS: A three-page survey was sent out via postal mail to 76 different hospitals addressing the topics indication, contraindication, follow-up and anticoagulation. RESULTS: Forty-three hospitals completed the survey: the median number of TIPS/year was 28.6 ± 23. Ascites and hydrothorax were announced as the main indications. Bilirubin levels above 5 mg/dl, hepatic encephalopathy and cardiac disease were considered as absolute contraindications in most hospitals, but age was not. The biggest variations were reported with regard to anticoagulation after TIPS procedure. Four hospitals never used any anticoagulation; most hospitals reported the use of low molecular weight heparins for a period of days up to 4 weeks. But also aspirin or clopidogrel was used after TIPS insertion in eight different hospitals. Additionally, the standards for follow-up after TIPS insertion were different in the hospitals. CONCLUSIONS: There is no consensus how to handle indication, contraindications and anticoagulation after the TIPS procedure. A national and international consensus is warranted to improve the outcome of TIPS patients and reduce secondary complications. In addition to compare results and efficacy in the future standard operation procedures as proposed here need to be put in place.
OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) insertion is an established treatment to lower portal pressure. There are no obligatory evidence-based recommendations addressing procedure and anticoagulation. Therefore, a survey was performed to establish current practice at different German hospitals. METHODS: A three-page survey was sent out via postal mail to 76 different hospitals addressing the topics indication, contraindication, follow-up and anticoagulation. RESULTS: Forty-three hospitals completed the survey: the median number of TIPS/year was 28.6 ± 23. Ascites and hydrothorax were announced as the main indications. Bilirubin levels above 5 mg/dl, hepatic encephalopathy and cardiac disease were considered as absolute contraindications in most hospitals, but age was not. The biggest variations were reported with regard to anticoagulation after TIPS procedure. Four hospitals never used any anticoagulation; most hospitals reported the use of low molecular weight heparins for a period of days up to 4 weeks. But also aspirin or clopidogrel was used after TIPS insertion in eight different hospitals. Additionally, the standards for follow-up after TIPS insertion were different in the hospitals. CONCLUSIONS: There is no consensus how to handle indication, contraindications and anticoagulation after the TIPS procedure. A national and international consensus is warranted to improve the outcome of TIPS patients and reduce secondary complications. In addition to compare results and efficacy in the future standard operation procedures as proposed here need to be put in place.
Authors: Carsten Meyer; Alba Maria Paar Pérez; Johannes Chang; Alois Martin Sprinkart; Nina Böhling; Andreas Minh Luu; Daniel Kütting; Christian Jansen; Julian Luetkens; Leon Marcel Bischoff; Ulrike Attenberger; Christian P Strassburg; Jonel Trebicka; Karsten Wolter; Michael Praktiknjo Journal: Sci Rep Date: 2022-03-03 Impact factor: 4.379
Authors: Leon Louis Seifert; Philipp Schindler; Lukas Sturm; Wenyi Gu; Quentin Edward Seifert; Jan Frederic Weller; Christian Jansen; Michael Praktiknjo; Carsten Meyer; Martin Schoster; Christian Wilms; Miriam Maschmeier; Hartmut H Schmidt; Max Masthoff; Michael Köhler; Michael Schultheiss; Jan Patrick Huber; Dominik Bettinger; Jonel Trebicka; Moritz Wildgruber; Hauke Heinzow Journal: Hepatol Int Date: 2022-04-05 Impact factor: 9.029