Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT.
OBJECTIVE
Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy.


METHODS
Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg. Standard endotherapy protocol was continued in both groups. HVPG was again measured at 1 month of treatment.


RESULTS
Out of 129 patients of index esophageal variceal bleed, 59 patients were eligible and randomized into carvedilol (n = 30) and propranolol (n = 29). At 1 month of treatment, decrease in heart rate, mean arterial blood pressure (MAP) and HVPG was significant within each group (p = 0.001). Percentage decrease in MAP was significantly more in carvedilol group as compared to propranolol group (p = 0.04). Number of HVPG responders (HVPG decrease >20 % or below 12 mmHg) was significantly more in carvedilol group (22/29) as compared to propranolol group (14/28), p = 0.04.


CONCLUSIONS
Carvedilol is more effective in reducing portal pressure in patients with cirrhosis with esophageal bleed. Though a larger study is required to substantiate this, the results in this study are promising for carvedilol. Clinical trials online government registry (CTRI/2013/10/004119). Trial registration number CTRI/2013/10/004119.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.
Vipin
V
Gupta
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.
Ramakant
R
Rawat
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India.
Shalimar
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Teaching Block, Third Floor AIIMS, Ansari Nagar, New Delhi, 110029, India. ansaraya@yahoo.com.
Anoop
A
Saraya
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004932:Esophageal and Gastric Varices / Q000188:drug therapy*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006503:Hepatic Veins / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects*; D011412:Propanolamines / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D011433:Propranolol
Carvedilol; HVPG; Propranolol; Secondary prophylaxis