The use of rifaximin in the prevention of overt HE after TIPS

A study out of France investigated whether rifaximin is superior to placebo for prophylaxis of overt hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). The sample population included 197 patients who had a diagnosis of alcoholic cirrhosis and were scheduled for TIPS for intractable ascites or prevention of variceal rebleeding. Researchers randomized the participants into treatment and control arms. Rifaximin (600 mg twice daily) or placebo was administered starting 14 days before TIPS and for 168 days post-procedure. At followup, overt HE episodes were documented in 34% of the rifaximin recipients and 53% of the placebo recipients, with both groups presenting similar rates of adverse events and transplant-free survival. Based on acceptable tolerance and reduced risk for overt HE, the study authors concluded that rifaximin is viable for prevention of overt HE following TIPS. The benefits of the study drug beyond 6 months after TIPS should be further investigated, however.