Copyright ©The Author(s) 2023.
World J Gastroenterol. Jan 7, 2023; 29(1): 61-74
Published online Jan 7, 2023. doi: 10.3748/wjg.v29.i1.61
Table 1 Chemoprevention for hepatic decompensation in cirrhosis: Current and emerging therapies
Mechanism of action
Primary benefits
Potential adverse effects
Other limitations
Supported by RCT
NSBBsβ1 and β2 blockade; α1 blockade (carvedilol)Decreased portal pressureHypotension, bradycardia, fatigueDosing frequency (propranolol)Yes
StatinsInhibition of HMG-CoA reductaseDecreased inflammation and endothelial dysfunctionMyopathy, hepatitis, diabetesOngoing
RifaximinBroad-spectrum, gut-specific antibioticReduced dysbiosis and bacterial translocationGastrointestinal upsetCostIncluded patients with prior decompensation
AnticoagulantsInactivation of clotting factorsReduced endothelial dysfunctionHemorrhageSQ injection (enoxaparin), dosing (warfarin)Included patients with prior decompensation
ACE inhibitorsInhibition of angiotensin II productionDecreased portal pressure1Hypotension, AKI, electrolyte derangements, angioedemaNo
ARBsInhibition of angiotensin II type 1 receptorDecreased portal pressureHypotension, AKI, electrolyte derangementsNo
MRAsInhibition of the aldosterone receptor in the distal nephronDecreased portal pressureHypotension, AKI, electrolyte derangementsGynecomastia (spironolactone)Only in combination with NSBB
SGLT2 inhibitorsInhibition of proximal tubule sodium-glucose cotransporterDecreased portal pressureElectrolyte derangements, mycotic genital infectionsCost, risk of ketoacidosis in AUDNo
AlbuminAnionic carrier protein with pleiotropic propertiesReduced inflammation; increased effective circulating volumeVolume overloadCost, intravenous administrationIncluded patients with prior decompensation