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Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis

Konstantinos Malandris1, Paschalis Paschos1,2, Anastasia Katsoula1

  • 1Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).

Annals of Gastroenterology
|May 2, 2019
PubMed

Insights

Carvedilol shows comparable efficacy and safety to standard treatments for preventing variceal bleeding in cirrhosis patients. This beta-blocker is a viable option for both primary and secondary prevention strategies.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Clinical Pharmacology

Background:

  • Beta-blockers are standard for preventing variceal bleeding.
  • Cirrhosis patients are at high risk for variceal bleeding.
  • Carvedilol's role in prevention requires thorough assessment.

Purpose of the Study:

  • To evaluate carvedilol's efficacy and safety.
  • To compare carvedilol against placebo and active interventions.
  • To assess carvedilol for primary and secondary variceal bleeding prevention.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched Medline, Embase, CENTRAL, and gray literature.
  • Data synthesized using random effects models; evidence strength assessed by GRADE.

Main Results:

  • 13 RCTs with 1598 patients included.
  • Carvedilol demonstrated similar efficacy to EVL and propranolol for primary prevention.
  • Carvedilol showed comparable efficacy to EVL, NSBBs + ISMN, and propranolol for secondary prevention.
  • Carvedilol was associated with lower all-cause mortality versus EVL.
  • No significant differences in safety profiles compared to EVL and NSBBs.
  • Confidence in effect estimates was very low across outcomes.

Conclusions:

  • Carvedilol is as efficacious as standard interventions for variceal bleeding prevention.
  • Carvedilol exhibits a similar safety profile to current standard-of-care treatments.
  • Carvedilol represents a potential alternative for primary and secondary prevention of variceal bleeding.
Abstract

Keywords:
Carvedilolmeta-analysisvariceal bleeding

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