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Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high risk of treatment failure and short-term mortality. Treatment and\/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic portosystemic shunts (TIPSs), especially in the preemptive situation, have been found to efficiently control bleeding, prevent rebleeding, and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.<\/jats:p>","DOI":"10.1055\/a-2107-0576","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T23:26:45Z","timestamp":1686180405000},"page":"189-205","source":"Crossref","is-referenced-by-count":7,"title":["To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure"],"prefix":"10.1055","volume":"43","author":[{"given":"Wenyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany"},{"name":"Medical Department I, Frankfurt University Hospital, Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Kimmann","sequence":"additional","affiliation":[{"name":"Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wim","family":"Laleman","sequence":"additional","affiliation":[{"name":"Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany"},{"name":"Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Praktiknjo","sequence":"additional","affiliation":[{"name":"Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Department of Medical Clinic B, University Hospital Muenster, Muenster, Germany"},{"name":"European Foundation for Study of Chronic Liver Failure, Barcelona, Spain"},{"name":"Department of Gastroenterology and Hepatology, Odense University Hospital, 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