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 anticoagulation with
heparin which is used in different centers is still unclear. 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 placement were randomized into the treatment group (n = 24) who received
phenprocoumon and a control group (n = 25). After 11 to 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach.
Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 11 of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete occlusion of the shunt, whereas no occlusion in the treatment group was observed (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 that 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
phenprocoumon treatment in the first 3 months after
TIPSS placement. Thereafter shunt occlusion was not observed and further
phenprocoumon treatment seemed unnecessary.