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Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding.
- Source :
-
Journal of hepatology [J Hepatol] 2014 Nov; Vol. 61 (5), pp. 1014-9. Date of Electronic Publication: 2014 Jun 19. - Publication Year :
- 2014
-
Abstract
- Background & Aims: Rebleeding after an initial oesophageal variceal haemorrhage remains a significant problem despite therapy with band ligation, non-selective β-blockers or a combination of these. Carvedilol is a vasodilating non-selective β-blocker with alpha-1 receptor and calcium channel antagonism. A recent study has suggested it is effective in the prevention of a first variceal bleed. Our aim was to compare oral carvedilol with variceal band ligation (VBL) in the prevention of rebleeding following a first variceal bleed.<br />Methods: Patients who were stable 5 days after presentation with a first oesophageal variceal haemorrhage and had not been taking β-blockers were randomised to oral carvedilol or VBL. Patients were followed-up after one week, monthly, then every 3 months. The primary end point was variceal rebleeding on intention-to-treat analysis.<br />Results: 64 patients were randomised, 33 to carvedilol and 31 to VBL. 58 (90.6%) patients had alcohol related liver disease. Age and Child-Pugh score were similar in both groups at baseline. Median follow-up was 26.3 (interquartile range [IQR] 10.2-46.6)months. Compliance was 68% and 65% for carvedilol and VBL respectively (p=0.993) and serious adverse events between the two groups were similar (p=0.968). Variceal rebleeding occurred during follow-up in 12 (36.4%) and 11 (35.5%) patients in the carvedilol and VBL groups, respectively (p=0.857), with 9 (27.3%) and 16 (51.6%) deaths in each group, respectively (p=0.110).<br />Conclusions: Carvedilol is not superior to VBL in the prevention of variceal rebleeding. The trend to a survival benefit for patients taking this drug compared with those undergoing banding requires further exploration.<br /> (Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adrenergic beta-Antagonists adverse effects
Adult
Blood Pressure drug effects
Carbazoles adverse effects
Carvedilol
Esophageal and Gastric Varices prevention & control
Female
Gastrointestinal Hemorrhage prevention & control
Heart Rate drug effects
Humans
Ligation
Male
Medication Adherence
Middle Aged
Propanolamines adverse effects
Recurrence
Adrenergic beta-Antagonists therapeutic use
Carbazoles therapeutic use
Esophageal and Gastric Varices drug therapy
Esophageal and Gastric Varices surgery
Gastrointestinal Hemorrhage drug therapy
Gastrointestinal Hemorrhage surgery
Propanolamines therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0641
- Volume :
- 61
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 24953021
- Full Text :
- https://doi.org/10.1016/j.jhep.2014.06.015