Acute propranolol administration effectively decreases portal pressure in patients with TIPS dysfunction. Transjugular intrahepatic portosystemic shunt.
OBJECTIVE
Up to 60% of patients treated with transjugular intrahepatic portosystemic shunt (TIPS) require angioplasty or restenting during the first year of follow up because of TIPS dysfunction (stenosis of the intrahepatic shunt increasing the portal pressure gradient above the 12 mm Hg threshold). We hypothesised that in patients with TIPS stenosis, propranolol administration, by decreasing portal inflow, would markedly decrease portal pressure.


METHODS
Eighteen patients with TIPS dysfunction were investigated by measuring portal pressure gradient before and after acute propranolol administration (0.2 mg/kg intravenously; n=18).


RESULTS
Propranolol markedly reduced the portal pressure gradient (from 16.6 (3.5) to 11.9 (4.8) mm Hg; p<0.0001), cardiac index (-26 (7)%), and heart rate (-18 (7)%) (p<0.0001). Portal pressure gradient decreased to less than 12 mm Hg in nine patients, more frequently in those with moderate dysfunction (portal pressure gradient 16 mm Hg) than in patients with severe dysfunction (portal pressure gradient >16 mm Hg) (8/10 v 1/8; p=0.015).


CONCLUSIONS
Propranolol therapy may delay the increase in portal pressure and reduce the need for reintervention in patients with TIPS dysfunction.
Bellis
L
L
Hepatic Hemodynamic Laboratory, Liver Unit, IMD, Hospital Clínic, Institut d'Investigacions Biomédiques August Pi I Sunyer, University of Barcelona, Spain.
Moitinho
E
E
Abraldes
J G
JG
Graupera
M
M
García-Pagán
J C
JC
Rodés
J
J
Bosch
J
J
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000601:surgery*; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011433:Propranolol / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D011433:Propranolol