Table 2.
Treatment Options for Patients With Cirrhosis and Ascites
| First‐Line Treatment |
| Cessation of alcohol use, when present |
| Sodium‐restricted diet and diet education |
| Dual diuretics, usually spironolactone and furosemide, orally with single daily dosing |
| Discontinue nonsteroidal anti‐inflammatory drugs |
| Evaluation for liver transplantation |
| Second‐Line Treatment |
| Discontinue beta blockers, angiotensin‐converting enzyme inhibitors, and angiotensin receptor blockers |
| Consider adding midodrine especially in the profoundly hypotensive patient |
| Serial therapeutic paracenteses |
| Evaluation for liver transplantation |
| Transjugular intrahepatic portosystemic shunt |
| Third‐Line Treatment |
| Peritoneovenous shunt (e.g., LeVeen or Denver shunt; rarely performed because other options are superior with less complications and better outcomes) |
Adapted with permission from Hepatology.2 Copyright 2013, American Association for the Study of Liver Diseases.