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Carvedilol for reducing portal pressure in primary prophylaxis of variceal bleeding: a dose‐response study
Author(s) -
Schwarzer R.,
Kivaranovic D.,
Paternostro R.,
Mandorfer M.,
Reiberger T.,
Trauner M.,
PeckRadosavljevic M.,
Ferlitsch A.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14576
Subject(s) - carvedilol , medicine , portal venous pressure , portal hypertension , cirrhosis , gastroenterology , ascites , blood pressure , cardiology , heart failure
Summary Background Sequential measurements of hepatic venous pressure gradient ( HVPG ) are used to assess the haemodynamic response to nonselective betablockers ( NSBB s) in patients with portal hypertension. Aims To assess the rates of HVPG response to different doses of carvedilol. Methods Consecutive patients with cirrhosis undergoing HVPG ‐guided carvedilol therapy for primary prophylaxis of variceal bleeding between 08/2010 and 05/2015 were retrospectively included. After baseline HVPG measurement, carvedilol 6.25 mg/d was administered and HVPG response ( HVPG ‐decrease ≥20% or to ≤12 mm Hg) was assessed after 3‐4 weeks. In case of nonresponse, carvedilol dose was increased to 12.5 mg/d and a third HVPG ‐measurement was performed after 3‐4 weeks. We also assessed HVPG ‐response rates according to the Baveno VI consensus ( HVPG decrease ≥10% or to ≤12 mm Hg) and changes in systolic arterial pressure ( SAP ). Results Seventy‐two patients (Child A, 37%; B, 35%; C, 28%) were included. 28 (39%) patients achieved a HVPG ‐decrease ≥ 20% with carvedilol 6.25 mg/d and another 10 (14%) with carvedilol 12.5 mg/d. Forty (56%) patients had a HVPG decrease ≥10% with carvedilol 6.25 mg/d and 24 (33%) with carvedilol 12.5 mg/d. Thus, in total, a HVPG ‐response of ≥20% and ≥10% and was achieved in 38 (53%) and 55 (76%) and of patients respectively. Notably, 6 patients (n = 4 with ascites) did not tolerate an increase to 12.5 mg/d due to hypotension/bradycardia. However, none of the other patients had a SAP < 90 mm Hg at the final HVPG measurement. Conclusion Carvedilol 12.5 mg/d was more effective than 6.25 mg/d in decreasing HVPG in primary prophylaxis. A total of 76% of patients achieved a HVPG ‐response of ≥ 10% to carvedilol 12.5 mg/d, however, arterial hypotension might occur, especially in patients with ascites.