title: Lack of clinical or haemodynamic rebound after abrupt interruption of beta-blockers in patients with cirrhosis.
abstract: BACKGROUND
  Beta-blockers may have to be interrupted in patients with cirrhosis. The concept of a rebound after interruption of beta-blockers is based on an animal study and on isolated case reports of variceal bleeding.
  
  
  OBJECTIVE
  To determine if a rebound occurs in patients with cirrhosis following abrupt interruption of beta-blockers.
  
  
  METHODS
  We prospectively included all consecutive patients with cirrhosis undergoing right heart and hepatic vein catheterisation. Four groups were defined: 'no beta-blockers' including patients not receiving beta-blockers; '≤1 day', '2-3 days' and '≥4 days' classified according to the time patients had interrupted beta-blockers before catheterisation. Results were expressed as median (interquartile range).
  
  
  RESULTS
  A total of 150 patients were included. Among the 25 patients in the groups '2-3 days' and '≥4 days', median duration of beta-blockers interruption was 4 (3-6) days. No gastrointestinal bleeding occurred during that period, nor during the following month. Hepatic venous pressure gradient was not different among patients in usually treated with beta-blockers. After adjustment, beta-blockers interruption was not associated with hepatic venous pressure gradient. Cardiac index was higher in the '≥4 days' group [4.6 L/min/m(2) (3.5-5.1)] than in the '≤1 day' group [3.4 (2.6-4.0); P = 0.001] or in the '2-3 days' group [3.1 (2.7-3.7); P = 0.007], but not different from the 'no beta-blockers' group.
  
  
  CONCLUSIONS
  Abrupt interruption of beta-blockers is associated neither with an apparent increase in the risk of variceal bleeding nor with a haemodynamic rebound. Thus, interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance.
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Payancé
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: J
authors.initials: J
authors.lastname: Bissonnette
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Roux
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: L
authors.initials: L
authors.lastname: Elkrief
authors.affiliation: DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: N
authors.initials: N
authors.lastname: Gault
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|CRI UMR1149, Clichy, France.
authors.forename: C
authors.initials: C
authors.lastname: Francoz
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: O
authors.initials: O
authors.lastname: Nekachtali
authors.affiliation: DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|CRI UMR1149, Clichy, France.|Service de chirurgie hépato-biliaire et transplantation, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: O
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|CRI UMR1149, Clichy, France.
authors.forename: D
authors.initials: D
authors.lastname: Lebrec
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|CRI UMR1149, Clichy, France.
authors.forename: D
authors.initials: D
authors.lastname: Valla
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|CRI UMR1149, Clichy, France.
authors.forename: F
authors.initials: F
authors.lastname: Durand
authors.affiliation: Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.|DHU Unity, Hôpital Beaujon, APHP, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|INSERM, U970, Paris Cardiovascular Research Center - PARCC, Paris, France.
authors.forename: P-E
authors.initials: PE
authors.lastname: Rautou
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists