Rifaximin may prevent hepatic encephalopathy after TIPS in patients with cirrhosis

In a randomized controlled trial, the antibiotic rifaximin used before and after transjugular intrahepatic portosystemic shunt (TIPS) placement, a minimally invasive procedure for treating portal hypertension-related complications of cirrhosis, helped to prevent hepatic encephalopathy compared to placebo. Adverse events were similar in both groups. The findings are published in Annals of Internal Medicine.

Potential complications of TIPS include shunt dysfunction and the development of hepatic encephalopathy. The rate of shunt dysfunction has been dramatically reduced by the use of polytetrafluoroethylene-covered stents, but hepatic encephalopathy still occurs in 35% to 50% of patients. According to U.S. and European guidelines published in 2014, no prophylactic therapy is recommended to prevent overt hepatic encephalopathy after TIPS placement in these patients.