Improving Management of Portal Hypertension: The Potential Benefit of Non-Etiological Therapies in Cirrhosis

J Clin Med. 2023 Jan 25;12(3):934. doi: 10.3390/jcm12030934.

Abstract

Portal hypertension is the consequence of cirrhosis and results from increased sinusoidal vascular resistance and hepatic blood inflow. Etiological therapies represent the first intervention to prevent a significant increase in portal pressure due to chronic liver damage. However, other superimposed pathophysiological drivers may worsen liver disease, including inflammation, bacterial translocation, endothelial dysfunction, and hyperactivation of hemostasis. These mechanisms can be targeted by a specific class of drugs already used in clinical practice. Albumin, rifaximin, statins, aspirin, and anticoagulants have been tested in cirrhosis and were a topic of discussion in the last Baveno consensus as non-etiological therapies. Based on the pathogenesis of portal hypertension in cirrhosis, our review summarizes the main mechanisms targeted by these drugs as well as the clinical evidence that considers them a valid complementary option to manage patients with cirrhosis and portal hypertension.

Keywords: albumin; anticoagulation; cirrhosis; non etiological therapies; portal hypertension; rifaximin; statins.

Publication types

  • Review

Grants and funding

The study was (partially) supported by the Italian Ministry of Health—Bando Ricerca Corrente 2022.