Stanley, A. J. et al. (2014) Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding. Journal of Hepatology, 61(5), pp. 1014-1019. (doi: 10.1016/j.jhep.2014.06.015) (PMID:24953021)
Full text not currently available from Enlighten.
Abstract
Background & Aims: Rebleeding after an initial oesophageal variceal haemorrhage remains a significant problem despite therapy with band ligation, non-selective β-blockers or a combination of these. Carvedilol is a vasodilating non-selective β-blocker with alpha-1 receptor and calcium channel antagonism. A recent study has suggested it is effective in the prevention of a first variceal bleed. Our aim was to compare oral carvedilol with variceal band ligation (VBL) in the prevention of rebleeding following a first variceal bleed. Methods: Patients who were stable 5 days after presentation with a first oesophageal variceal haemorrhage and had not been taking β-blockers were randomised to oral carvedilol or VBL. Patients were followed-up after one week, monthly, then every 3 months. The primary end point was variceal rebleeding on intention-to-treat analysis. Results: 64 patients were randomised, 33 to carvedilol and 31 to VBL. 58 (90.6%) patients had alcohol related liver disease. Age and Child-Pugh score were similar in both groups at baseline. Median follow-up was 26.3 (interquartile range [IQR] 10.2–46.6) months. Compliance was 68% and 65% for carvedilol and VBL respectively (p = 0.993) and serious adverse events between the two groups were similar (p = 0.968). Variceal rebleeding occurred during follow-up in 12 (36.4%) and 11 (35.5%) patients in the carvedilol and VBL groups, respectively (p = 0.857), with 9 (27.3%) and 16 (51.6%) deaths in each group, respectively (p = 0.110). Conclusions: Carvedilol is not superior to VBL in the prevention of variceal rebleeding. The trend to a survival benefit for patients taking this drug compared with those undergoing banding requires further exploration.
Item Type: | Articles |
---|---|
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Smith, Dr Lyn and Mills, Professor Peter and Stanley, Dr Adrian and Gaya, Mr Daniel and Forrest, Dr Ewan |
Authors: | Stanley, A. J., Dickson, S., Hayes, P. C., Forrest, E. H., Mills, P. R., Tripathi, D., Leithead, J. A., MacBeth, K., Smith, L., Gaya, D. R., Suzuki, H., and Young, D. |
College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
Journal Name: | Journal of Hepatology |
Publisher: | Elsevier |
ISSN: | 0168-8278 |
ISSN (Online): | 1600-0641 |
Published Online: | 19 June 2014 |
University Staff: Request a correction | Enlighten Editors: Update this record