{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T07:55:01Z","timestamp":1786780501864,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2018,12,10]],"date-time":"2018-12-10T00:00:00Z","timestamp":1544400000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>\n                    Patients admitted with acute variceal bleeding (AVB) and Child\u2010Pugh C score (CP\u2010C) or Child\u2010Pugh B plus active bleeding at endoscopy (CP\u2010B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p\u2010TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high\u2010risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p\u2010TIPS was based on individual center policy. p\u2010TIPS in the setting of AVB is associated with a lower mortality in CP\u2010C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a00.002). Mortality rate in CP\u2010B+AB patients was low, and p\u2010TIPS did not improve it. In CP\u2010C and CP\u2010B+AB patients, p\u2010TIPS reduced treatment failure and rebleeding (1\u2010year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a00.017) and development of\n                    <jats:italic toggle=\"yes\">de novo<\/jats:italic>\n                    or worsening of previous ascites without increasing rates of hepatic encephalopathy.\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    p\u2010TIPS must be the treatment of choice in CP\u2010C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p\u2010TIPS could be a good treatment strategy for CP\u2010B+AB patients.\n                  <\/jats:p>","DOI":"10.1002\/hep.30182","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T02:52:16Z","timestamp":1531795936000},"page":"282-293","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":179,"title":["Preemptive\u2010TIPS Improves Outcome in High\u2010Risk Variceal Bleeding: An Observational Study"],"prefix":"10.1097","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7937-984X","authenticated-orcid":false,"given":"Virginia","family":"Hern\u00e1ndez\u2010Gea","sequence":"first","affiliation":[{"name":"Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic\u2010Institut d\u2019Investigacions Biom\u00e8diques August Pi I i Sunyer, IMDIM,University of Barcelona,Barcelona,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica Red de enfermedades hep\u00e1ticas y digestivas,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Procopet","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology \u201cOctavian Fodor\u201d, Hepatology Department and \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 3rd Medical Clinic,Cluj\u2010Napoca,Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro","family":"Gir\u00e1ldez","sequence":"additional","affiliation":[{"name":"Clinical Management Unit of Digestive Diseases,University Hospital Virgen del Rocio,Seville,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucio","family":"Amitrano","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit,Ospedale A 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CIBERehd,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0831-8422","authenticated-orcid":false,"given":"Joan","family":"Genesc\u00e0","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica Red de enfermedades hep\u00e1ticas y digestivas,Madrid,Spain"},{"name":"Liver Unit,Hospital Universitari Vall d\u2019Hebron, Vall d\u2019Hebron Institute of Research (VHIR), Universitat Aut\u00f2noma de Barcelona and CIBERehd,Barcelona,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bureau","sequence":"additional","affiliation":[{"name":"Department of Hepato\u2010Gastroenterology,Purpan Hospital, CHU Toulouse,INSERM U858,University of Toulouse,France,Toulouse,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7028-3881","authenticated-orcid":false,"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I,University of Bonn,Bonn,Germany"},{"name":"European Foundation for the Study of Chronic Liver Failure (EF\u2010Clif),Barcelona,Spain"},{"name":"Institute for Bioengineering of Catalonia,Barcelona,Spain"},{"name":"Department of Gastroenterology and Hepatology,Odense University Hospital,Odense,Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elba","family":"Llop","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica Red de enfermedades hep\u00e1ticas y digestivas,Madrid,Spain"},{"name":"Liver Unit, Hospital U, Puerta de Hierro. 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