for Health Care Providers
Table 3. Management strategy in the prevention of recurrent variceal hemorrhage (secondary prophylaxis)
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BID, twice a day; bpm, beats/min; CTP, Child-Turcotte-Pugh; TIPS, transjugular intrahepatic portosystemic shunt; QD, once daily. | ||
| First-line therapy | Nonselective 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
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