Mária Szántová, Zuzana Petrakovičová
The work presents current concept of primary and secondary prevention of varicous bleeding on basis of international consensus Baveno IV. (2005), Methodological letter of rational pharmacotherapy „Treatment and prevention of bleeding in portal hypertension“ (January 2008) and international conference in Atlanta (2007). Primary prevention of portal hypertension is a summation of measures performed before the first oesophageal bleeding. The first choice drug in patients with big varixes is non- selective beta-blocker (nBB). Carvedilol is the most suitable. It has, besides reduction of portal pressure, a positive profile, affects markers of endothelial dysfunction and the rate of its beta-blocking effect is proportionate to the level of hepatic dysfunction. In contraindication or intolerance of vBB ligation is indicated or combination of nBB with nitrates. Secondary prevention involves a summation of measures beginning with the sixth day after the first bleeding. Combination of ligation a nBB is recommended. In case of failure TIPS or surgical cut-off is recommended. Hepatovenous gradient measuring is the only exact method to define the level of PH.