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Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed

Hepatology, ISSN: 0270-9139, Vol: 50, Issue: 3, Page: 825-833
2009
  • 236
    Citations
  • 0
    Usage
  • 169
    Captures
  • 0
    Mentions
  • 30
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    236
    • Citation Indexes
      225
    • Clinical Citations
      6
      • PubMed Guidelines
        6
    • Policy Citations
      5
      • Policy Citation
        5
  • Captures
    169
  • Social Media
    30
    • Shares, Likes & Comments
      30
      • Facebook
        30

Article Description

Current therapy for preventing the first variceal bleed includes beta-blocker and variceal band ligation (VBL). VBL has lower bleeding rates, with no differences in survival, whereas beta-blocker therapy can be limited by side effects. Carvedilol, a non-cardioselective vasodilating beta-blocker, is more effective in reducing portal pressure than propranolol; however, there have been no clinical studies assessing the efficacy of carvedilol in primary prophylaxis. The goal of this study was to compare carvedilol and VBL for the prevention of the first variceal bleed in a randomized controlled multicenter trial. One hundred fifty-two cirrhotic patients from five different centers with grade II or larger esophageal varices were randomized to either carvedilol 12.5 mg once daily or VBL performed every 2 weeks until eradication using a multibander device. Seventy-seven patients were randomized to carvedilol and 75 to VBL. Baseline characteristics did not differ between the groups (alcoholic liver disease, 73%; median Child-Pugh score, 8; median age, 54 years; median follow-up, 20 months). On intention-to-treat analysis, carvedilol had lower rates of the first variceal bleed (10% versus 23%; relative hazard 0.41; 95% confidence interval 0.19-0.96 [P = 0.04]), with no significant differences in overall mortality (35% versus 37%, P = 0.71), and bleeding-related mortality (3% versus 1%, P = 0.26). Six patients in the VBL group bled as a result of banding ulcers. Per-protocol analysis revealed no significant differences in the outcomes. Conclusion: Carvedilol is effective in preventing the first variceal bleed. Carvedilol is an option for primary prophylaxis in patients with high-risk esophageal varices. Copyright © 2009 by the American Association for the Study of Liver Diseases.

Bibliographic Details

Tripathi, Dhiraj; Ferguson, James W.; Kochar, Narendra; Leithead, Joanna A.; Therapondos, George; Mcavoy, Norma C.; Stanley, Adrian J.; Forrest, Ewan H.; Hislop, William S.; Mills, Peter R.; Hayes, Peter C.

Ovid Technologies (Wolters Kluwer Health)

Medicine

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