How is decompensation prevented in compensated cirrhosis with clinically significant portal hypertension?

{{c1::Treat the underlying cause of chronic liver disease (e.g. alcohol abstinence)}}
{{c1::β-blocker (preferably carvedilol)}}

How is decompensation prevented in compensated cirrhosis with clinically significant portal hypertension?<br><br>{{c1::Treat the underlying cause of chronic liver disease (e.g. alcohol abstinence)}}<br>{{c1::β-blocker (preferably carvedilol)}}

Variceal surveillance required in those who cannot tolerate β-blockers

The nonselective beta blockers, carvedilol and propranolol, are both effective in lowering portal pressure. However, carvedilol has additional vasodilator activity (as it blocks both alpha and beta receptors), producing a greater reduction in portal pressure compared with propranolol, and less systemic hypotension for an equivalent effect on portal pressure

In the absence of clinically significant portal hypertension, beta blockers have no proven benefit in cirrhosis.

Variceal surveillance required in those who cannot tolerate β-blockers<br><br>The nonselective beta blockers, carvedilol and propranolol, are both effective in lowering portal pressure. However, carvedilol has additional vasodilator activity (as it blocks both alpha and beta receptors), producing a greater reduction in portal pressure compared with propranolol, and less systemic hypotension for an equivalent effect on portal pressure<br><br>In the&nbsp;absence&nbsp;of clinically significant portal hypertension, beta blockers have no proven benefit in cirrhosis.<br><br><div>Titrate the dose against clinical tolerance; maintain resting heart rate above 60&nbsp;beats per minute and systolic blood pressure above 90&nbsp;mmHg. Patients taking beta blockers to prevent decompensation do not require endoscopic surveillance as it will not change management.</div>

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eTG - Prevention of decompensation in patients with compensated cirrhosis https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Liver Disorders&topicfile=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1&guidelinename=auto&sectionId=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1#c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1 Published June 2023, Accessed 10 October 2024

eTG - Prevention of decompensation in patients with compensated cirrhosis <a href="https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&amp;guidelinePage=Liver%20Disorders&amp;topicfile=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1&amp;guidelinename=auto§ionId=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1#c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1">https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&amp;guidelinePage=Liver Disorders&amp;topicfile=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1&amp;guidelinename=auto&amp;sectionId=c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1#c_LDG_Prevention-of-decompensation-in-patients-with-compensated-cirrhosis_topic_1</a> Published June 2023, Accessed 10 October 2024

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