Evaluation of Carvedilol in Prevention of First Attack of Variceal Hemorrhage in Patients with Liver Cirrhosis

Mahmod, Ahmad; Essa, Samy Aziz Gebraiel; Aal, Eman Abdel; Dawod, Hosam M

doi:10.21608/aeji.2012.15955

Cited by 3 publications

(10 citation statements)

References 14 publications

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“…The characteristics of the seven included trials are listed in Table 1. The studies were conducted in Egypt (n=3),13,18,19 UK (n=2),20,21 Pakistan (n=1),17 and Austria (n=1) 16. Six studies compared the efficacy and safety of carvedilol with EBL for prevention of the first variceal bleeding, while only one study compared the effects of carvedilol with EBL for the prevention of variceal rebleeding 20.…”

Section: Resultsmentioning

confidence: 99%

“…The mean age of participants ranged from 47.2 to 55 years, with a majority of male patients (59%) when the gender ratio was reported in six studies 13,16–18,20,21. Four studies reported that the etiology of portal hypertension was chronic viral cirrhosis,13,16,17,19 while three trials demonstrated that alcohol liver disease was the primary reason for cirrhosis 18,20,21. The most common complication of cirrhosis – ascites, was reported in six studies.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 43.34% of included patients (270/623) had concomitant ascites with different severity. Moreover, six trials applied the percentage of Child–Pugh class (A/B/C) to assess the liver function and the majority of patients were found to be class B or C (69.03%) 13,16–19,21. However, only one study used the form of mean (IQR) to represent the score of Child–Pugh class and the mean score was 9 (7.0–10.5) in carvedilol group and 9 (8.0–11.0) in EBL group 20.…”

Section: Resultsmentioning

confidence: 99%

“…Another two clinical trials used 25 mg/day as long-run dose if patients could tolerate 13,16. The endpoint of EBL in all included studies was obliteration of varices except for one trial, which defined endpoint of EBL as esophageal varices being either grade I or complete obliteration 19. The interval of EBL in selected studies varied from 2 to 4 weeks.…”

Section: Resultsmentioning

confidence: 99%

“…Among seven included trials, five studies were associated with a low risk of bias,16–18,20,21 one study19 was assessed as unclear risk of bias, and one trial was evaluated as high risk of bias 13Figure 2 shows the quality of the included studies as assessed by Review Manager software.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

<p>Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis</p>

Tian¹,

Li²,

Guo³

et al. 2019

TCRM

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ObjectiveVariceal hemorrhage is the primary driver of mortality in patients with portal hypertension. Recent guidelines recommended that patients with esophageal varices should receive endoscopic band ligation (EBL) or carvedilol as prophylaxis of variceal bleeding. Several clinical trials have compared carvedilol use with EBL intervention, yielding controversial results. The present study aimed to perform a meta-analysis of randomized controlled trials (RCTs) evaluating the benefits and harms of carvedilol vs EBL for the prevention of variceal bleeding.MethodsStudies were searched on Pubmed, Embase, Medline, and Cochrane library databases up to August 2018. Main outcomes in selected studies (variceal bleeding, all-cause deaths, bleeding-related deaths, and adverse events) were pooled into a meta-analysis.ResultsSeven RCTs were identified in this meta-analysis, including a total of 703 patients. A total of 359 patients were randomized to carvedilol group and 354 were randomized to EBL group. No significant difference in variceal bleeding was observed between carvedilol use and EBL groups (relative ratio [RR] =0.86, 95% CI =0.60–1.23, I2=11%), without publication bias. No significant difference was found neither for all-cause deaths (RR =0.82, 95% CI =0.44–1.53, I2=66%) nor for bleeding-related deaths (RR =0.85, 95% CI =0.39–1.87, I2=42%) in four included studies. Moreover, no reduced trend was observed toward adverse events in carvedilol group compared with that in EBL group (RR =1.32, 95% CI =0.75–2.31, I2=81%).ConclusionThere is no significant difference between carvedilol use and EBL intervention for the prophylaxis of variceal bleeding in patient with esophageal varices. Large-scale clinical trials are further needed to make a confirmed conclusion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

<p>Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis</p>

Tian¹,

Li²,

Guo³

et al. 2019

TCRM

View full text Add to dashboard Cite

show abstract

Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis

Villanueva¹,

Torres²,

Sarin³

et al. 2022

Journal of Hepatology

103

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Lowering hepatic venous pressure agent carvedilol versus variceal banding ligation for clinical outcomes of cirrhotic portal hypertension

Wei

Shao

et al. 2018

TCRM

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ObjectiveCarvedilol is nonselective beta-blocker with a mild anti-alpha-1-adrenergic effect. Several studies proposed improved hemodynamic effects of carvedilol compared with propanolol. Our study was to perform a systematic review and meta-analysis of randomized control trials comparing carvedilol with variceal banding ligation (VBL).MethodsStudies were searched on online databases MEDLINE, EMBASE(Ovid), the Cochrane Library, Chinese Wanfang Database, and China National Knowledge Infrastructure between January 2000 and May 2018. Incidence of bleeding and mortality were main outcome measures. Subgroup analysis and sensitivity analysis were conducted to ensure the robustness of pooled estimates.ResultsTen randomized control trials including 1,269 cirrhotic patients were chosen. Compared with VBL, carvedilol showed similar preventive efficacy of risk ratios (RRs) in variceal bleeding, and bleeding-related mortality over different follow-up periods from 6 months to 24 months. Also, significant differences between carvedilol and VBL in overall mortality and other causes of mortality were failed to be found. Carvedilol achieved a lower incidence of portal hypertension gastropathy in both 6 months (RR=0.49, 95% CI: 0.38–0.64, P<0.00001) and 12 months (RR=0.35, 95% CI: 0.26–0.47, P<0.00001). Two trials compared combination of carvedilol and VBL with VBL alone; however, the results failed to find an improved preventive efficacy of bleeding (RR=0.71, 95% CI: 0.15–3.30, P=0.67).ConclusionCarvedilol is equivalent to invasive VBL for variceal bleeding prevention. It can be well tolerated and may be of benefit to portal hypertension gastropathy. However, available data during 24 months follow-up did not support a potential advantage of carvedilol for prognosis as a lowering hepatic venous pressure agent.

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Evaluation of Carvedilol in Prevention of First Attack of Variceal Hemorrhage in Patients with Liver Cirrhosis

Cited by 3 publications

References 14 publications

<p>Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis</p>

<p>Carvedilol vs endoscopic band ligation for the prevention of variceal bleeding: a meta-analysis</p>

Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis

Lowering hepatic venous pressure agent carvedilol versus variceal banding ligation for clinical outcomes of cirrhotic portal hypertension

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