Safety of Discontinuing NSBBs in Cirrhotic Patients With Managed Primary Aetiological Factors

Ki vehet részt

• Aged 18 years or above
• Evidence of cirrhosis, based on either radiological and/or clinical features
• History of varices, variceal haemorrhage or portal hypertension warranting NSBB
• Removal or suppression of the primary aetiological factor (i.e., sustained virological response in chronic hepatitis C, complete hepatitis B virus DNA suppression in chronic hepatitis B, and long-term alcohol abstinence in alcohol-related liver disease)
• LSM <25 kPa
• Provision of written informed consent

Ki nem vehet részt

• Active aetiological factors not addressed in the inclusion criteria (e.g., autoimmune or hereditary liver diseases). However, hepatic steatosis-commonly coexisting with other liver diseases-is not an exclusion criterion unless accompanied by high plasma alanine aminotransferase >40 U/L or confirmed steatohepatitis
• Current or history of hepatocellular carcinoma
• Radiological evidence of portal vein thrombosis
• History of liver transplantation or liver resection
• Other clinical indications for NSBB (e.g., cardiovascular disease, arterial hypertension)
• Recent hepatic decompensation within the past year (total bilirubin >50 μmol/L, prothrombin time >1.3 times the upper normal limit [unless attributable to use of anti-coagulation], albumin <35 g/L, or presence of ascites, variceal haemorrhage or hepatic encephalopathy). Notably, the Baveno VI criteria used LSM <20-25 kPa and normal platelet count >150×109/L to rule out varices requiring treatment (19). However, in line with the Baveno VII consensus, which sets an LSM <25 kPa as the threshold for considering NSBB discontinuation, thrombocytopenia is not an exclusion criterion to allow the cohort to include a wider spectrum of patients
• History of other malignancies (unless in complete remission for >5 years)
• Contraindications to undergoing endoscopy