From the Guidelines
Aspirin is not recommended for patients with non-cirrhotic portal hypertension who have esophageal varices due to the increased risk of variceal bleeding, as evidenced by the lack of discussion on its use in the management of non-cirrhotic portal hypertension in the most recent guidelines 1. The management of non-cirrhotic portal hypertension with esophageal varices should focus on primary treatments for portal hypertension and varices, including:
- Non-selective beta-blockers (such as propranolol 20-40 mg twice daily or nadolol 20-40 mg once daily) to reduce portal pressure, as supported by studies showing their beneficial effects on splanchnic haemodynamics 1
- Endoscopic band ligation for medium to large varices, which has been shown to be effective in reducing the incidence of bleeding in patients with non-cirrhotic portal hypertension 1 If aspirin is absolutely necessary for another indication (like cardiovascular disease), it should be used at the lowest effective dose (typically 81 mg daily) and only after careful risk-benefit assessment by a specialist, considering the size of varices, history of bleeding, severity of portal hypertension, and the strength of the indication for aspirin. Close monitoring for signs of gastrointestinal bleeding is essential if aspirin must be used, including watching for melena, hematemesis, or unexplained anemia, as the risk of bleeding is a major concern in these patients 1. It is also important to note that the guidelines recommend managing portal hypertension according to the guidelines elaborated for cirrhosis, which do not include the use of aspirin for primary prevention of variceal bleeding 1.
From the Research
Role of Aspirin in Non-Cirrhotic Portal Hypertension with Esophageal Varices
There is no direct evidence in the provided studies regarding the role of Aspirin (acetylsalicylic acid) in non-cirrhotic portal hypertension with esophageal varices.
Alternative Treatments
- The studies suggest that beta-blockers, such as propranolol, are effective in preventing variceal bleeding in patients with noncirrhotic portal hypertension 2, 3, 4, 5.
- Endoscopic variceal ligation (EVL) is also a recommended treatment for preventing variceal bleeding in these patients 2, 3, 6.
- Other treatments, such as vasoactive drugs (e.g. terlipressin, somatostatin) and transjugular intrahepatic portosystemic shunts, may also be used in certain cases 3, 4.
Key Findings
- Beta-blockers have been shown to reduce the risk of variceal bleeding and improve survival in patients with noncirrhotic portal hypertension 3, 4, 5.
- EVL is effective in preventing variceal bleeding and may be used as an alternative to beta-blockers in patients who are unable to tolerate them 2, 3, 6.
- The choice of treatment depends on various factors, including the patient's underlying condition, the severity of the varices, and the presence of any contraindications to certain treatments 3, 4.