Beta blocker prophylaxis for patients with variceal hemorrhage.
OBJECTIVE
To characterize beta blocker therapy for the primary and secondary prevention of variceal hemorrhage.


BACKGROUND
Variceal hemorrhage is one of the more frequent and severe complications of portal hypertension due to liver disease. Beta blocker therapy has been demonstrated to decrease risk of first bleed in patients with evidence of varices and recurrent bleeding and mortality in patients with history of prior variceal hemorrhage.


METHODS
A total of 106 patients with liver disease hospitalized with suspected variceal hemorrhage were retrospectively reviewed.


RESULTS
Half of patients had known varices, 44 (41.5%) of whom had experienced prior variceal hemorrhage. Only 21 (20%) were receiving beta blocker therapy at admission and 41 (48%) at discharge. The majority were not receiving therapy for primary prophylaxis (94%). Specific characteristics associated with beta blocker use could not be identified, although more patients with history of greater than two variceal hemorrhages were receiving beta blocker at admission (73% vs. 41%, P = 0.04)


CONCLUSIONS
This study suggests that liver disease patients with varices are often not receiving beta blocker therapy to reduce risk of first or subsequent variceal hemorrhage. Opportunity exists to optimize use of this proven prophylactic treatment and bridge an apparent gap in standard of care.
Wilbur
Kerry
K
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. kwilbur@interchange.ubc.ca
Sidhu
Kirhan
K
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol