How do you decide between empiric carvedilol versus obtaining HVPG to confirm CSPH when noninvasive markers suggest CSPH but there is limited hemodynamic/renal reserve (borderline MAP and/or CKD)?
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In your practice, would you proceed with CSPH confirmation via pressure measurement OR pursue empiric carvedilol if non-invasive markers already suggest CSPH?
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2 Answers
Mednet MemberInvited Expert
Hepatology · Northwestern
Answered on
May be reasonable to consider EGD to assess for varices and/or band high risk especially if the patient ultimately cannot tolerate carvedilol.
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Mednet MemberInvited Expert
Hepatology · University of Texas at Austin Dell Medical School
Answered on
I’m not sure how HVPG measurement would change your management other than confirming presence of CSPH, which you already have signs of noninvasively. I would consider low dose carvedilol trial with a low threshold to stop if not tolerated and screen for varices.
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