PHENPROCOUMON FOR PREVENTION OF SHUNT OCCLUSION AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT - A RANDOMIZED TRIAL

Development of stenosis or occlusion of the transjugular intrahepatic portosystemic stent shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoa gulation with heparin which is used in different centers is still uncl ear. In the present study, we evaluated the effect of phenprocoumon on shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child's A and B cirrhosis, who underwent successful TIPSS placeme nt were randomized into the treatment group (n = 24) who received phen procoumon and a control group (n = 25). After 11 to 13 weeks, all pati ents were admitted and had a reevaluation that included control angiog raphy by transjugular approach. Phenprocoumon treatment was stopped af ter the first reevaluation and both groups were followed for 1 year af ter randomization. During the 3-month treatment period 11 of 22 patien ts of the treatment group and 12 of 23 patients of the control group r equired reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete occlusio n of the shunt, whereas no occlusion in the treatment group was observ ed (P <.05). During the mean follow-up of 8 months after the treatment was stopped, in both groups stenosis occurred in 50% of patients, but no further occlusion of the stent was observed. These data indicate t hat occlusion of the stent is related to thrombosis, whereas stenosis does not appear to be dependent on blood coagulation. In patients with preserved liver function occlusion of the shunt may be prevented by p henprocoumon treatment in the first 3 months after TIPSS placement. Th ereafter shunt occlusion was not observed and further phenprocoumon tr eatment seemed unnecessary.