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Carvedilol Appears Effective in Preventing Variceal Bleeding in Cirrhotic Patients HOBOKEN, NJ -- August 19, 2009 -- A study published in the journal Hepatology shows that carvedilol is as effective in the prevention of variceal haemorrhaging as variceal band ligation (VBL). Dhiraj Tripathi, MD, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom, and colleagues enlisted 152 patients with cirrhosis who also had grade 2 or larger oesophageal varices that had not bled. Researchers treated 77 patients with carvedilol, while 75 patients underwent VBL every 2 weeks until eradication. Patients were administered carvedilol orally at a starting dose of 6.25 mg per day, increasing to a target dose of 12.5 mg per day. Results showed 10% of patients receiving carvedilol and 23% of patients treated by VBL experienced variceal bleeding during the follow-up period. There was no difference in survival rates between the 2 groups. "The greater efficacy of carvedilol in the prevention of the first variceal bleed is an important finding of this study," said Dr. Tripathi. "No other randomised trial has demonstrated drug therapy to have an advantage over VBL." While researchers concluded carvedilol had greater effectiveness in treating portal hypertension than endoscopic therapy, there were limitations to their study. "Measurements of hepatic venous-pressure gradient (HVPG) were not included as part of the study, making it difficult to determine if the benefit of carvedilol was due to a greater HVPG response or failure of the VBL, noted Jaime Bosch, MD, Hepatic Hemodynamic Laboratory Hospital Clinic, Barcelona, Spain, in an editorial published in the same issue of the journal. Propranolol, another NSBB drug commonly used to treat portal hypertension, was not included as part of this study. "Further studies are required to assess whether carvedilol is a better option than standard NSBB," added Dr. Bosch. SOURCE: Wiley Blackwell E-mail this page to a friend or colleague! To print, use this version