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Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT.
Hepatol Int 2017; 11(2):181-187HI

Abstract

BACKGROUND AND AIMS

Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy.

METHODS

Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg. Standard endotherapy protocol was continued in both groups. HVPG was again measured at 1 month of treatment.

RESULTS

Out of 129 patients of index esophageal variceal bleed, 59 patients were eligible and randomized into carvedilol (n = 30) and propranolol (n = 29). At 1 month of treatment, decrease in heart rate, mean arterial blood pressure (MAP) and HVPG was significant within each group (p = 0.001). Percentage decrease in MAP was significantly more in carvedilol group as compared to propranolol group (p = 0.04). Number of HVPG responders (HVPG decrease >20 % or below 12 mmHg) was significantly more in carvedilol group (22/29) as compared to propranolol group (14/28), p = 0.04.

CONCLUSION

Carvedilol is more effective in reducing portal pressure in patients with cirrhosis with esophageal bleed. Though a larger study is required to substantiate this, the results in this study are promising for carvedilol. Clinical trials online government registry (CTRI/2013/10/004119). Trial registration number CTRI/2013/10/004119.

Authors+Show Affiliations

Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India. ansaraya@yahoo.com.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27624505

Citation

Gupta, Vipin, et al. "Carvedilol Versus Propranolol Effect On Hepatic Venous Pressure Gradient at 1 Month in Patients With Index Variceal Bleed: RCT." Hepatology International, vol. 11, no. 2, 2017, pp. 181-187.
Gupta V, Rawat R, Shalimar , et al. Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT. Hepatol Int. 2017;11(2):181-187.
Gupta, V., Rawat, R., Shalimar, ., & Saraya, A. (2017). Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT. Hepatology International, 11(2), pp. 181-187. doi:10.1007/s12072-016-9765-y.
Gupta V, et al. Carvedilol Versus Propranolol Effect On Hepatic Venous Pressure Gradient at 1 Month in Patients With Index Variceal Bleed: RCT. Hepatol Int. 2017;11(2):181-187. PubMed PMID: 27624505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT. AU - Gupta,Vipin, AU - Rawat,Ramakant, AU - Shalimar,, AU - Saraya,Anoop, Y1 - 2016/09/13/ PY - 2016/06/16/received PY - 2016/08/25/accepted PY - 2016/9/15/pubmed PY - 2017/7/28/medline PY - 2016/9/15/entrez KW - Carvedilol KW - HVPG KW - Propranolol KW - Secondary prophylaxis SP - 181 EP - 187 JF - Hepatology international JO - Hepatol Int VL - 11 IS - 2 N2 - BACKGROUND AND AIMS: Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy. METHODS: Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg. Standard endotherapy protocol was continued in both groups. HVPG was again measured at 1 month of treatment. RESULTS: Out of 129 patients of index esophageal variceal bleed, 59 patients were eligible and randomized into carvedilol (n = 30) and propranolol (n = 29). At 1 month of treatment, decrease in heart rate, mean arterial blood pressure (MAP) and HVPG was significant within each group (p = 0.001). Percentage decrease in MAP was significantly more in carvedilol group as compared to propranolol group (p = 0.04). Number of HVPG responders (HVPG decrease >20 % or below 12 mmHg) was significantly more in carvedilol group (22/29) as compared to propranolol group (14/28), p = 0.04. CONCLUSION: Carvedilol is more effective in reducing portal pressure in patients with cirrhosis with esophageal bleed. Though a larger study is required to substantiate this, the results in this study are promising for carvedilol. Clinical trials online government registry (CTRI/2013/10/004119). Trial registration number CTRI/2013/10/004119. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/27624505/Carvedilol_versus_propranolol_effect_on_hepatic_venous_pressure_gradient_at_1_month_in_patients_with_index_variceal_bleed:_RCT_ L2 - https://dx.doi.org/10.1007/s12072-016-9765-y DB - PRIME DP - Unbound Medicine ER -