Primary and Secondary Prophylaxis of Variceal Bleeding

Use NSBBs early to prevent 1° decompensation and not just variceal bleed. Consider NSBBs in clinically signifi cant portal hypertension/varices (or any other manifestation of PHTN).

NSBBs + EVL are fi rst-line therapy for 2° prophylaxis. TIPS should be considered in case of rebleed despite adequate NSBB and endotherapy or recurrent ascites.

Any one alone can be used in case of unavailability or intolerance. Statins have been shown to have additive effect to NSBB + EVL, but currently they are not recommended.


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