Tags

Type your tag names separated by a space and hit enter

Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial.
J Hepatol 2014; 60(4):757-64JH

Abstract

BACKGROUND & AIMS

Esophageal variceal bleed is a major problem in patients with cirrhosis. Endoscopic variceal ligation (EVL) has been shown to be equal to or better than propranolol in preventing first bleed. Carvedilol is a non-selective β blocker with alpha-1 adrenergic blocker activity. Hemodynamic studies have shown carvedilol to be more effective than propranolol at reducing portal pressure. We compared efficacy of carvedilol with EVL for primary prophylaxis of esophageal variceal bleed.

METHODS

Cirrhotic patients with esophageal varices were randomized to carvedilol 12.5mg daily or EVL at three university hospitals of Pakistan. End points were esophageal variceal bleeding, death or liver transplant.

RESULTS

Two hundred and nine patients were evaluated. Eighty two and eighty six patients were randomized in carvedilol and EVL arms respectively. Mean age was 48 ± 12.2 years; 122 (72.7%) were males; 89.9% had viral cirrhosis; mean Child-Pugh score was 7.3 ± 1.6 and mean follow up was 13.3 ± 12.1 months (range 1-50 months). Both EVL and carvedilol groups had comparable variceal bleeding rates (8.5% vs. 6.9%), bleed related mortality (4.6% vs. 4.9%) and overall mortality (12.8% vs. 19.5%) respectively. Adverse events in carvedilol group were hypotension (n=2), requiring cessation of therapy, while transient nausea (n=18) and dyspnea (n=30) resolved spontaneously. In the EVL arm, post banding ulcer bleed (n=1) and chest pain (n=17), were termed as serious adverse events while transient dysphagia (n=58) resolved without treatment.

CONCLUSIONS

Although our study is underpowered, the findings suggest that carvedilol is probably not superior to EVL in preventing first variceal bleed in patients with viral cirrhosis.

Authors+Show Affiliations

Section of Gastroenterology, Aga Khan University, Karachi, Pakistan. Electronic address: hasnain.alishah@aku.edu.National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Section of Gastroenterology, Aga Khan University, Karachi, Pakistan.Medical Unit VII, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24291366

Citation

Shah, Hasnain Ali, et al. "Carvedilol Vs. Esophageal Variceal Band Ligation in the Primary Prophylaxis of Variceal Hemorrhage: a Multicentre Randomized Controlled Trial." Journal of Hepatology, vol. 60, no. 4, 2014, pp. 757-64.
Shah HA, Azam Z, Rauf J, et al. Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial. J Hepatol. 2014;60(4):757-64.
Shah, H. A., Azam, Z., Rauf, J., Abid, S., Hamid, S., Jafri, W., ... Munir, S. M. (2014). Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial. Journal of Hepatology, 60(4), pp. 757-64. doi:10.1016/j.jhep.2013.11.019.
Shah HA, et al. Carvedilol Vs. Esophageal Variceal Band Ligation in the Primary Prophylaxis of Variceal Hemorrhage: a Multicentre Randomized Controlled Trial. J Hepatol. 2014;60(4):757-64. PubMed PMID: 24291366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carvedilol vs. esophageal variceal band ligation in the primary prophylaxis of variceal hemorrhage: a multicentre randomized controlled trial. AU - Shah,Hasnain Ali, AU - Azam,Zahid, AU - Rauf,Javeria, AU - Abid,Shahab, AU - Hamid,Saeed, AU - Jafri,Wasim, AU - Khalid,Abdullah, AU - Ismail,Faisal Wasim, AU - Parkash,Om, AU - Subhan,Amna, AU - Munir,Syed Mohammad, Y1 - 2013/11/28/ PY - 2013/07/19/received PY - 2013/11/19/revised PY - 2013/11/20/accepted PY - 2013/12/3/entrez PY - 2013/12/3/pubmed PY - 2015/5/12/medline KW - Carvedilol KW - Cirrhosis KW - Endoscopic variceal ligation KW - Portal hypertension KW - Primary prophylaxis KW - Randomized controlled trial KW - Variceal hemorrhage SP - 757 EP - 64 JF - Journal of hepatology JO - J. Hepatol. VL - 60 IS - 4 N2 - BACKGROUND & AIMS: Esophageal variceal bleed is a major problem in patients with cirrhosis. Endoscopic variceal ligation (EVL) has been shown to be equal to or better than propranolol in preventing first bleed. Carvedilol is a non-selective β blocker with alpha-1 adrenergic blocker activity. Hemodynamic studies have shown carvedilol to be more effective than propranolol at reducing portal pressure. We compared efficacy of carvedilol with EVL for primary prophylaxis of esophageal variceal bleed. METHODS: Cirrhotic patients with esophageal varices were randomized to carvedilol 12.5mg daily or EVL at three university hospitals of Pakistan. End points were esophageal variceal bleeding, death or liver transplant. RESULTS: Two hundred and nine patients were evaluated. Eighty two and eighty six patients were randomized in carvedilol and EVL arms respectively. Mean age was 48 ± 12.2 years; 122 (72.7%) were males; 89.9% had viral cirrhosis; mean Child-Pugh score was 7.3 ± 1.6 and mean follow up was 13.3 ± 12.1 months (range 1-50 months). Both EVL and carvedilol groups had comparable variceal bleeding rates (8.5% vs. 6.9%), bleed related mortality (4.6% vs. 4.9%) and overall mortality (12.8% vs. 19.5%) respectively. Adverse events in carvedilol group were hypotension (n=2), requiring cessation of therapy, while transient nausea (n=18) and dyspnea (n=30) resolved spontaneously. In the EVL arm, post banding ulcer bleed (n=1) and chest pain (n=17), were termed as serious adverse events while transient dysphagia (n=58) resolved without treatment. CONCLUSIONS: Although our study is underpowered, the findings suggest that carvedilol is probably not superior to EVL in preventing first variceal bleed in patients with viral cirrhosis. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/24291366/Carvedilol_vs__esophageal_variceal_band_ligation_in_the_primary_prophylaxis_of_variceal_hemorrhage:_a_multicentre_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(13)00820-9 DB - PRIME DP - Unbound Medicine ER -