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If there is no response to thrombolytic therapy, either a surgical shunt or a transjugular intrahepatic portosystemic shunt (TIPS) may be used

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A reasonable monitoring approach might look like this: First 3 Months: Week 2: Basic kidney function and urine test Month 1: B12 level, homocysteine, kidney function Month 3: Full panel repeat Months 4-12: Every 3 months: Comprehensive monitoring Monthly kidney checks if function is below 60 Adjust doses based on trends After Year 1: Every 6 months: Full monitoring panel Annual: More advanced tests if needed Ongoing: Pay attention to how you feel and any symptoms How can you actually implement these strategies without it becoming overwhelming or expensive