Carvedilol untuk Tata Laksana Clinically Significant Portal Hypertension pada Sirosis Kompensata
DOI:
https://doi.org/10.55175/cdk.v50i3.660Keywords:
CSPH, NSBB, sirosis kompensataAbstract
Hipertensi portal merupakan konsekuensi klinis dari sirosis hati. Angka kematian karena hipertensi portal masih tinggi di Indonesia. Pada kondisi sirosis kompensata munculnya hipertensi portal yang signifikan secara klinis (clinically significant portal hypertension/CSPH) dapat memprediksi kejadian dekompensasi dan merupakan penanda prognosis penyakit yang lebih buruk. Diagnosis CSPH dapat dengan cara invasif ataupun non-invasif. Tata laksana CSPH pada kondisi sirosis kompensata diutamakan untuk mencegah timbulnya dekompensasi sirosis. Pemberian penghambat beta non-selektif (non-selective beta blocker/NSBB) pada kondisi sirosis kompensata efektif menurunkan hipertensi portal dan mampu mencegah dekompensasi.
Portal hypertension is a major consequences of liver cirrhosis. Mortality rate from portal hypertension is quite high in Indonesia. In patients with liver cirrhosis, the development of clinically significant portal hypertension (CSPH) is predictive for decompensation and worse prognosis. Diagnosis of CSPH can be carried out by either invasive or non-invasive methods. The aim of CSPH management in compensated cirrhosis is to prevent the incidence of decompensation. Management of compensated cirrhosis with non-selective beta blocker (NSBB) has been shown to reduce portal hypertension and the incidence of first decompensation.
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References
Pusdatin Kemenkes RI. Situasi dan analisis hepatitis. Kementerian Kesehatan RI. 2014.
Sudeshna M, Kumkum S, Mehebubar R, Soumendra NH. Clinical and etiological study on chronic liver diseases. Int J Contemp Med Surg Radiol. 2018;3(2):77-80.
Perhimpunan Peneliti Hati Indonesia. Konsensus penatalaksanaan hipertensi portal di Indonesia. Jakarta: PPHI; 2021.
Kibrit J, Khan R, Jung BH, Koppe S. Clinical assessment and management of portal hypertension. Semin Intervent Radiol. 2018;35(3):153-9. doi:10.1055/s-0038-1660793
Gananandan K, Mookerjee R, Jalan R. Use of non-selective beta blockers in decompensated cirrhosis and ACLF. Curr Hepatol Rep 2022;21:29-36. https://doi.org/10.1007/s11901-022-00584-2
European Association for the Study of the Liver. EASL clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236. doi: 10.1016/j.jhep.2018.03.019.
Engelmann C, Clària J, Szabo G, Bosch J, Bernardi M. Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. J Hepatol. 2021;75 Suppl 1(Suppl 1):49-66. doi: 10.1016/j.jhep.2021.01.002.
Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353(21):2254-61. doi: 10.1056/NEJMoa044456.
Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World J Gastroenterol. 2020;26(40):6111-40. doi: 10.3748/wjg.v26.i40.6111.
Bosch J, Pizcueta P, Feu F, Fernández M, García-Pagán JC. Pathophysiology of portal hypertension. Gastroenterol Clin North Am. 1992;21(1):1-14.
Iwakiri Y, Trebicka J. Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy. JHEP Rep. 2021;3(4):100316. doi: 10.1016/j.jhepr.2021.100316.
Burhanudin M, Nusi I, Setiawan P, Purbayu H, Sugihartono T, Maimunah U, et al. Pharmacological therapy of portal hypertension. Proc Surabaya International Physiology Seminar (SIPS); 2017. pp. 389-96.
Iwakiri Y. Endothelial dysfunction in the regulation of cirrhosis and portal hypertension. Liver Int. 2012;32(2):199-213. doi:10.1111/j.1478-3231.2011.02579.x
Rodríguez-Vilarrupla A, Fernández M, Bosch J, García-Pagán JC. Current concepts on the pathophysiology of portal hypertension. Ann Hepatol. 2007;6(1):28-36.
Iwakiri Y. Pathophysiology of portal hypertension. Clin Liver Dis. 2014;18(2):281-91. doi: 10.1016/j.cld.2013.12.001.
Bochnakova T. Hepatic venous pressure gradient. Clin Liver Dis (Hoboken). 2021;17(3):144-8. doi: 10.1002/cld.1031.
Kim JN, Sohn KM, Kim MY, Suk KT, Jeong SW, Jung HE,et al. Relationship between the hepatic venous pressure gradient and first variceal hemorrhage in patients with cirrhosis: A multicenter retrospective study in Korea. Clin Mol Hepatol. 2012;18(4):391-6. doi: 10.3350/cmh.2012.18.4.391.
Thabut D, Moreau R, Lebrec D. Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 2011;53:683-94. https://doi.org/10.1002/hep.24129
Snowdon VK, Guha N, Fallowfield JA. Noninvasive evaluation of portal hypertension: Emerging tools and techniques. Internat J Hepatol. 2012;2012:691089. https://doi.org/10.1155/2012/691089
Kim MY, Jeong WK, Baik SK. Invasive and non-invasive diagnosis of cirrhosis and portal hypertension. World J Gastroenterol. 2014;20(15):4300-15. doi: 10.3748/wjg.v20.i15.4300.
Castera L, Pinzani M, Bosch J. Non invasive evaluation of portal hypertension using transient elastography. J Hepatol. 2012;56(3):696-703. doi: 10.1016/j.jhep.2011.07.005.
Abraldes JG, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, et al. Anticipate investigators. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study. Hepatology 2016;64(6):2173-84. doi: 10.1002/hep.28824.
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-74. doi: 10.1016/j.jhep.2021.12.022.
Kirnake V, Arora A, Sharma P, Goyal M, Chawlani R, Toshniwal J, et al. Non-invasive aspartate aminotransferase to platelet ratio index correlates well with invasive hepatic venous pressure gradient in cirrhosis. Indian J Gastroenterol. 2018;37(4):335-41. doi: 10.1007/s12664-018-0879-0.
Sauerbruch T, Schierwagen R, Trebicka J. Managing portal hypertension in patients with liver cirrhosis. F1000Res. 2018;7:F1000 Faculty Rev-533. doi: 10.12688/f1000research.13943.1.
Lens S, Rincón D, García-Retortillo M, Albillos A, Calleja JL, Bañares R, et al. Association between severe portal hypertension and risk of liver decompensation in patients with hepatitis C, regardless of response to antiviral therapy. Clin Gastroenterol Hepatol. 2015;13(10):1846-53.e1. doi: 10.1016/j.cgh.2015.04.013.
Bari K, Garcia-Tsao G. Treatment of portal hypertension. World J Gastroenterol. 2012;18(11):1166-75. doi: 10.3748/wjg.v18.i11.1166.
Benmassaoud A, Tsochatzis EA. The use of statins in the management of chronic liver disease. AME Med J 2018;3:3. doi: 10.21037/amj.2017.12.07
Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol 2014;60:643-53. doi: 10.1016/j.jhep.2013.09.016.
Rodrigues SG, Mendoza YP, Bosch J. Beta-blockers in cirrhosis: Evidence-based indications and limitations. JHEP Rep. 2019;2(1):100063. doi: 10.1016/j.jhepr.2019.12.001.
Villanueva C, Albillos A, Genesca J, Garcia-Pagan J, Calleja J, Aracil C, et al. Beta blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): A randomised, double blind, placebo-controlled, multicentre trial. Lancet 2019;393;1597-608.
Abid S, Ali S, Baig MA, Waheed AA. Is it time to replace propranolol with carvedilol for portal hypertension? World J Gastrointest Endosc 2015;7(5):532-9. doi: 10.4253/wjge.v7.i5.532.
Bañares R, Moitinho E, Matilla A, García-Pagán JC, Lampreave JL, Piera C, et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 2002;36(6):1367-73. doi:10.1053/jhep.2002.36947
Jachs M, Hartl L, Simbrunner B, Bauer D, Paternostro R, Balcar L, et al. Carvedilol achieves higher hemodynamic response and lower rebleeding rates than propranolol in secondary prophylaxis. Clin Gastroenterol Hepatol. 2022. doi: https://doi.org/10.1016/ j.cgh.2022.06.007.
Marrone G, Maeso-Diaz R, Garcia-Cardena G, Abraldes JG, García-Pagán JC, Bosch J, et al. KLF2 exerts antifibrotic and vasoprotective effects in cirrhotic rat livers: Behind the molecular mechanisms of statins. Gut 2015;64:1434-43.
Lebrec D, Poynard T, Hillon P, Benhamou JP. Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: A controlled study. N Engl J Med. 1981;305(23):1371-4.
Poynard T, Cales P, Pasta L, Ideo G, Pascal JP, Pagliaro L. Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group. N Engl J Med. 1991;324(22):1532–8.
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