Esophagael banding questions. Dotelet. What should my BP/heart rate be?

[kgillman]

I have a recent diagnosis of Portal Hypertension due to cirrhosis.  No biopsy was ever done.  No measurements on portal pressure was ever done.  My liver function is good.  My MELD Score is 10.  My spleen is enlarged.  My WBC and platelet counts are low.  Platelets usually around 50-60, but have been as high as 80-90 and one time dropped below 50 to 43.  I had my first EGD.  Due to my platelets being below 50 for the first and only time, they did not band.  Instead, they transfused platelets and banded on the next day.  They did 7 bands.  They don't want to have another procedure.  They want me to take Doptelet - a new and outrageously expensive drug that is not covered by my insurance.  My GI doctor and hepatologist do a very poor job explaining any thing.  First, is it rare to do banding right away?  I was expecting to do the EGD and not have to do any bands?  Second, why is Doptelet preferred over platelet transfusion.  Am I sicker than they are letting on - even though my liver function is good and MELD score is low?  Doesn't banding one are just cause pressure in other areas causing the need for more bands?  How many bands can a person have?  Are my doctors just bad communicators or does this just come due to the lack of knowledge of the disease?  I also have a lot of questions about Doptelet and concerned it may cause more problems that it cures.  Does anyone know?  What is the goal BP/Heart Rate?

[flyinlynn]

How are they diagnosing your cirrhosis? Have you had a fibrosure blood test or Fibroscan test (a machine similar to an ultrasound except it produces a thump to estimate liver stiffness)? Both those methods are able to estimate level of liver fibrosis and diagnose liver cirrhosis. An ultrasound can say the liver has a course appearance which resembles cirrhosis but generally not used to officially diagnose cirrhosis

[flyinlynn]

My MELD is 6 my liver enzymes are normal. My cirrhosis was diagnosed in 2008 with liver biopsy and re-confirmed in 2014 using a Fibroscan machine. My cirrhosis was caused by hepatitis c which is now cured since I finished successful treatment in May 2014

When my doctor found I had esophageal varicies he contacted me directly not his staff or office. I was on vacation. He wanted to get me in ASAP for treatment as an esophageal varicieal bleeding episode is a life threatening emergency. Bleeding varicies is one of the ways cirrhosis kills.

[flyinlynn]

I had 4 banding sessions done once a month for four months no idea how many bands per session. My esophageal varicies have not returned since 2012.

Having a very low platelet count is evidence of portal hypertension you don’t need to be tested

I could not take a beta blocker as the goal of a beta blocker is to reduce heart rate to less than 60 and my testing heart rate is around 57 and lower.

Doptelet is used to treat low platelet counts

“Indicated for thrombocytopenia in adults with chronic liver disease who are scheduled to undergo a procedure
Taken orally once daily for 5 consecutive days with food
Initiate dosing 10-13 days prior to the scheduled procedure
Patients should undergo their procedure 5-8 days after the last dose
Also see Administration
Dose based on preprocedure platelet count
Platelet count <40 x10^9/L: 60 mg (3 tablets) PO qDay x 5 days
Platelet count 40 to 10%

Pyrexia (8-11%)
1-10%

Abdominal pain (6-7%)
Nausea (6-7%)
Headache (4-7%)
Fatigue (3-4%)
Peripheral edema (3-4%)
<1%

Hyponatremia (0.7%)”

“Warnings
Contraindications

None
Cautions

Thrombotic/thromboembolic complications
Associated with thrombotic and thromboembolic complications in patients with chronic liver disease
Portal vein thrombosis reported with chronic liver disease in patients treated with thrombopoietin (TPO) receptor agonists (ADAPT-1 and ADAPT-2 clinical trials)
Consider the potential increased thrombotic risk when administering to patients with known risk factors for thromboembolism, including genetic prothrombotic conditions (eg, factor V Leiden, prothrombin 20210A, antithrombin deficiency, or protein C or S deficiency)
Do not administer to patients with chronic liver disease in an attempt to normalize platelet counts”