Impact of medication regimen on development of hepatic encephalopathy after transjugular intrahepatic portosystemic shuntin

Background:

Hepatic encephalopathy (HE) frequently occurs after transjugular intrahepatic portosystemic shunting (TIPS). Quality of life and long-term prognosis are impaired in patients with HE after TIPS. Lactulose and rifaximin are commonly administered pre- and post TIPS to prevent development of HE post TIPS. Influence of other medication is being discussed and unsatisfactorily clarified. The aim of this retrospective analysis is to investigate the preventive potential of lactulose and rifaximin in the treatment of patients pre- and post TIPS and further evaluate the impact of other commonly used drugs in cirrhotic patients on the probability of occurrence of HE post TIPS.

Methods:

This is a retrospective analysis of cirrhotic patients that received TIPS in our clinic (n = 131) using clinical data, laboratory findings and medication pre- and post TIPS. Observation period was twelve months.

Results:

One year after TIPS, 59.5% of patients had developed at least one episode of HE (one month post TIPS: 28.2%; six months post TIPS: 52.3%; HE severity according to West-Haven Criteria: I: 65.4%, II: 20.5%, III: 14.2%). Neither administration of lactulose pre- or post TIPS, nor administration of rifaximin pre- or post TIPS did significantly affect frequency of occurrence of HE episodes. Combined administration of both lactulose and rifaximin or other drugs commonly used in cirrhotic patients (loop diuretics, proton punp inhibitors, aldosterone antagonists, nonsteroidal anti-inflammatory drugs, anticoagulants) did also not affect occurrence of HE. Increased MELD-score (≥10), Child-Pugh-Turcotte-score B or C, age ≥65 years, impaired estimated glomerular filtration rate and pre TIPS portosystemic pressure gradient > 20 mmHg were identified as risk factors for development of HE post TIPS.

Conclusion:

Our analysis disconfirms beneficial effects of lactulose and/or rifaximin if administered pre- or post TIPS to prevent development of HE. Further studies are needed to validate these findings or identify special patient groups in which this medication regimen could be effective in preventing HE post TIPS anyway.