Non-selective β-blockers or endoscopic band ligation are recommended for primary prophylaxis of variceal bleeding in patients with esophageal varices.
Additional α-adrenergic blockade (as by carvedilol) may increase the number of patients with hemodynamic response.
Professor Markus Peck-Radosavljevic and colleagues from Austria examined patients with esophageal varices undergoing measurement of HVPG before and under propranolol treatment.
HVPG responders were kept on propranolol, while non-responders were placed on carvedilol.
Carvedilol responders continued treatment, while non-responders to carvedilol underwent endoscopic band ligation.
|Bleeding rates were 11% in patients on propranolol |
The research team's primary aim was hemodynamic response rates to carvedilol in propranolol non-responders.
The team found that 36% of patients showed a HVPG response to propranolol.
Among the propranolol non-responders 56% eventually achieved a hemodynamic response with carvedilol, while 44% of patients were finally treated with endoscopic band ligation.
The team found that the decrease in HVPG was significantly greater with carvedilol than with propranolol.
During a 2 year follow-up bleeding rates were 11% in patients on propanolol versus 5% in Carvedilol responders versus 25% with endoscopic band ligation.
The team observed fewer episodes of hepatic decompensation, and significantly lower mortality were observed in hemodynamic responders compared to the endoscopic band ligation group.
Professor Peck-Radosavljevic's team concludes, "Carvedilol leads to a significantly greater decrease in HVPG than propranolol."
"Using carvedilol for primary prophylaxis a substantial proportion of non-responders to propranolol can achieve a haemodynamic response, which is associated with improved outcome with regard to prevention of variceal bleeding, hepatic decompensation and death."