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EFFECT OF TIME TO TIPS ON OUTCOMES IN PATIENTS WITH VARICEAL BLEEDING

Date
May 19, 2024

Background: The pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) within 72 hours is recommended. Nevertheless, recent research emphasizes the challenges associated with the timely provision of TIPS within this limited timeframe. The objective of this study was to assess the impact of time for performing TIPS on patient outcomes and identify a more appropriate timeframe.
Method: This study enrolled patients referred to our hospital for TIPS procedure between January 2012 and December 2021. The duration between the recent variceal bleeding episode and the TIPS procedure was documented. Predetermined outcomes were assessed concerning various groups at four distinct time intervals: 72 hours, 5 days, 14 days, and 28 days. The primary outcome was the long-term survival rate.
Results: A total of 1180 patients were included in the study. There were no significant differences in patient outcomes between the early and late TIPS groups when patients were grouped by 72 hours, 14 days, and 28 days. However, when comparing the late TIPS (>5 days) group to the early TIPS (≤5 days) group, a significantly lower 5-year survival rate was observed in the late TIPS group (71.0% vs 80.4%; HR, 1.88; 95% CIs, 1.14-3.12; P = 0.014). The variceal rebleeding rate did not show a significant difference between the two groups (P = 0.91).
Conclusion: Early TIPS within a 5-day window may confer a survival benefit in contrast to TIPS procedures performed beyond this timeframe. It may be advisable to expand the timeframe for pre-emptive TIPS to align with current clinical practices.