Statins

The use of statins should be encouraged in patients with cirrhosis and an approved indication for statins since these agents may decrease portal pressure and improve overall survival.

In patients with Child-Pugh B and C cirrhosis, statins should be used at a lower dose (simvastatin at max. 20 mg/d) and patients should be followed closely for muscle and liver toxicity. In Child-Pugh C cirrhosis the benefit of statins has not been proven yet and their use should be more restrictive.

Aspirin

The use of aspirin should not be discouraged in patients with cirrhosis and an approved indication for aspirin, since it may reduce the risk of HCC, liver-related complications, and death.

Albumin

Long-term albumin administration may reduce complications of cirrhosis and improve transplant-free survival in patients with uncomplicated ascites, but a formal recommendation cannot be given until further data become available.

Short-term albumin administration is indicated for spontaneous bacterial peritonitis (SBP), acute kidney injury (AKI) >stage 1A, large-volume paracentesis and combined with terlipressin for hepatorenal syndrome (HRS)-AKI.

Antibiotic prophylaxis

Primary antibiotic prophylaxis is recommended in selected patients (i.e., gastrointestinal [GI] haemorrhage, Child-Pugh C cirrhosis with low protein ascites) at high risk of SBP.

Secondary antibiotic prophylaxis is indicated in patients with previous SBP.

Rifaximin is indicated for the secondary prophylaxis of hepatic encephalopathy.Rifaximin should be considered for prophylaxis of overt hepatic encephalopathy in patients with previous overt hepatic encephalopathy undergoing elective TIPS.

Rifaximin is not indicated beyond these indications, including primary or secondary prophylaxis of SBP.

Anticoagulants

Anticoagulation should not be discouraged in patients with cirrhosis and an approved indication for anticoagulation, since anticoagulation may reduce liver-related outcomes in patients with and without portal vein thrombosis (PVT) and may improve overall survival.

Direct-acting oral anticoagulants (DOACs) are as safe and effective for the prevention of cardiovascular events in patients with Child-Pugh A/B cirrhosis as in those without cirrhosis DOACs are not recommended in patients with Child-Pugh C cirrhosis outside study protocols.

References:

Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974] Journal of Hepatology, Vol. 77, Issue 2