660 Endoscopic Variceal Ligation Alone Versus Endoscopic Variceal Ligation Plus Carvedilol in Variceal Bleeding Prophylaxis in Cirrhotic Patients

Copaci, I.; Micu, L.; Mindrut, E.; Voiculescu, M

doi:10.1016/s0168-8278(12)60673-4

Cited by 5 publications

(2 citation statements)

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“…Meanwhile, outcome measures were certainly incidence of bleeding, which would be hard influence by personnel willing, so majority of them were judged to be adequate. Two trials reported a combination therapy of carvedilol and VBL,12,18 which was different from the others in aspects of comparison, and they were judged high risk of bias in other bias. Overall quality of the included trials is low to moderate (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…However, the current recommendations for VBL + drug therapy were not followed . Another abstract comparing VBL + carvedilol vs VBL in primary and secondary prophylaxis showed similar outcomes with reduced recurrence of varices in the primary prophylaxis group . Therefore, carvedilol is an attractive therapy owing to similar efficacy to current therapies with the potential for improved tolerability.…”

Section: Use Of Beta‐blockers In Patients With Gastro‐oesophageal Varmentioning

confidence: 99%

Beta‐blockers in portal hypertension: new developments and controversies

Tripathi

Hayes

2013

Liver International

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Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis

Roccarina

Best

Freeman

et al. 2021

Cochrane Database of Systematic Reviews

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660 Endoscopic Variceal Ligation Alone Versus Endoscopic Variceal Ligation Plus Carvedilol in Variceal Bleeding Prophylaxis in Cirrhotic Patients

Cited by 5 publications

References 0 publications

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

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

Beta‐blockers in portal hypertension: new developments and controversies

Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis

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