Medikamentöse Langzeittherapien zur Prognoseverbesserung bei Leberzirrhose und zur Vermeidung von Komplikationen der portalen Hypertension

Zusammenfassung

Die portale Hypertension bei Patienten mit Leberzirrhose kann nicht nur durch interventionelle (TIPS: transjugulärer portosystemischer Stent-Shunt) oder operative Shuntanlagen, sondern auch medikamentös beeinflusst werden. Zahlreiche Studien beschäftigten sich mit der Frage, ob diese Substanzen bei dauerhafter Gabe zu einer Prognoseverbesserung bei Patienten mit Leberzirrhose führen können. Nicht selektive Betablocker (NSBB), Statine, Antibiotika, Enoxaparin und Albumin haben viele Angriffspunkte in der Pathogenese der portalen Hypertension oder bei Dekompensation der Leberzirrhose, sodass sie grundsätzlich als Kandidaten für eine Langzeittherapie infrage kommen. Während es für NSBB, Antibiotika und Albumin klare Indikationen in der Versorgung von Patienten mit dekompensierter Leberzirrhose gibt, ist dies weniger geklärt für den Einsatz von Statinen oder Antikoagulanzien. Neuere Untersuchungen ergaben widersprüchliche Ergebnisse, wenn der primäre Endpunkt einer Studie die Prognoseverbesserung oder die Vermeidung einer Dekompensation der Zirrhose durch eine dauerhafte medikamentöse Therapie war. Zum jetzigen Zeitpunkt ergibt sich aufgrund der aktuellen Studienlage keine Veranlassung, das bisherige, in Leitlinien abgesicherte Vorgehen im täglichen Alltag zu ändern. Diese Übersicht gibt einen Überblick zum Einsatz von NSBB, Antibiotika, Statinen, Antikoagulanzien und Albumin bei Komplikationen der portalen Hypertension insbesondere im Hinblick auf ihren dauerhaften Einsatz zur Verbesserung des Überlebens von Patienten mit Leberzirrhose.

Abstract

Portal hypertension in patients with liver cirrhosis can be improved, not only by surgical or interventional shunt placements, but also by drug-only treatment. Many recent studies addressed the question whether any of these substances can improve survival of patients with liver cirrhosis when administered continuously for months and years. Non-selective beta-blockers (NSBB), statins, antibiotics, enoxaparin and albumin have been shown to possess many beneficial effects in the pathophysiology of portal hypertension or on events leading to decompensation of liver cirrhosis. Accordingly, they represent candidate drugs for long-term treatment to improve patient survival. In contrast to NSBB, antibiotics and albumin, which have clearly defined indications in the treatment of complications related to portal hypertension, the role of statins and anticoagulants in the management of these patients remains to be further elucidated. Recent studies came to opposing results when a permanent treatment was tested to improve patient prognosis or to prevent liver decompensation. At present, there is no reason to change our everyday practice beyond established management proposals published in practice guidelines. This paper gives an overview of present and future indications for treatment with NSBB, antibiotics, statins, anticoagulants and albumin with special reference to studies aiming at improving prognosis of patients with liver cirrhosis.

Schlüsselwörter

medikamentöse Therapie der portalen Hypertension - Komplikationen der Leberzirrhose - Prognoseverbesserung durch nicht selektive Betablocker, Statine, Albumin, Antibiotika und Enoxoparin

Key words

drug treatment of portal hypertension - complications of liver cirrhosis - non-selective beta-blockers and improvement of prognosis in liver cirrhosis - statines - albumin - antibiotics - enoxaparin

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