Version July 2025
TIPS: Transjugular intrahepatic portosystemic shunt.
* Patients with hepatic hydrothorax who do not have contraindications to liver transplantation should be referred for a transplantation evaluation.
¶ Initial diuretic doses are furosemide 40 mg daily and spironolactone 100 mg daily. If there is no response, diuretics may be increased in a stepwise fashion every three to five days by doubling the doses. Maximum doses are furosemide 160 mg daily and spironolactone 400 mg daily.
Δ Therapeutic thoracentesis can be performed periodically in conjunction with diuretic therapy.
◊ The decision to perform TIPS placement is individualized and informed by multidisciplinary assessment and by patient comorbidities that may be a contraindication to elective TIPS (eg, congestive heart failure). Refer to content on pre-TIPS evaluation for details.
§ We monitor TIPS patency with Doppler ultrasound between three and six months after placement and then at six month intervals for the first two years.