Portal Vein Obstruction Medication

Updated: Dec 27, 2016
  • Author: Adnan Said, MD, MSPH; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Beta-adrenergic blocking agents

Class Summary

Inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic stimulation. Doses to treat variceal bleeding vary. Long-term administration of oral propranolol has been used in doses of 20-360 mg/d. Randomized trials have used 20-120 mg/d. Gradually increase doses, with a goal of reducing the resting heart rate by 25%. Treatment efficacy may also be measured by reducing the hepatoportal venous gradient (HPVG) to less than 12.

Propranolol (Inderal)

Nonselective beta-blocker that reduces the risk of primary and recurrent variceal bleeding by decreasing the portal pressure. Indicated for primary and secondary prophylaxis of variceal bleeding.

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Somatostatin analogs

Class Summary

Have various effects on GI secretion, glandular secretion (eg, growth hormone, insulin, glucagon), and smooth muscle contraction. Inhibit splanchnic blood flow.

Octreotide (Sandostatin, Sandostatin LAR Depot)

Reduces portal flow, thereby reducing portal hypertension. Mechanism of action in this setting is not fully understood. Used in acute variceal bleeding and for recurrent bleeding after endoscopic therapy.

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Anticoagulants

Class Summary

Used in the treatment and prophylaxis of thromboembolic disorders. Include direct anticoagulants (eg, heparins, low molecular weight heparins, heparinoids) and indirect anticoagulants (eg, warfarin).

Warfarin (Coumadin)

Alters the synthesis of blood coagulation factors II, VII, IX, and X by interfering with the action of vitamin K.

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Thrombolytic agents

Class Summary

Fibrinolysis is the mechanism of clot dissolution. It is mediated by plasminogen, which circulates in the plasma in an inactive form; conversion to its active form, plasmin, occurs when plasminogen binds to fibrin in the presence of a plasminogen activator.

Alteplase (Activase)

Recombinant thrombolytic agent also known as tPA. Plasminogen activation results in the formation of plasmin, which is the enzyme responsible for clot dissolution.

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