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Viral Hepatitis

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Management strategy in the prevention of recurrent variceal hemorrhage (secondary prophylaxis)

for Health Care Providers

Table 3. Management strategy in the prevention of recurrent variceal hemorrhage (secondary prophylaxis)

Back to Cirrhosis Recommendations

BID, twice a day; bpm, beats/min; CTP, Child-Turcotte-Pugh; TIPS, transjugular intrahepatic portosystemic shunt; QD, once daily.

First-line therapyNonselective ß-blockers (propranolol, nadolol)Start propranolol (20 mg BID) or nadolol (20 mg QD)
Titrate to maximum tolerable dosage or a heart rate of 55-60 bpm
No need for repeat endoscopy
and
Endoscopic variceal ligation
Ligate every 1-2 weeks until variceal obliteration
First surveillance endoscopy 1-3 months after obliteration, then every 6-12 months
Second-line therapy (if combined pharmacologic+endoscopic treatment has failed)TIPS or
Shunt surgery (CTP class A patients, where available)

From Management and Treatment of Patients with Cirrhosis and Portal Hypertension