Patients with cirrhosis are at risk for developing portal hypertension that can lead to the formation, dilation, and rupture of esophageal varices. The annual incidence of esophageal varices is approximately 5% and one third of those will bleed.
In a recent study, researchers from the University of Edinburgh determined carvedilol was more effective in the prevention of variceal hemorrhaging than variceal band ligation (VBL), a common treatment used for the past 20 years. The results of the first clinical trial to test carvedilol for prevention of variceal hemorrhage are available in Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
Dhiraj Tripathi and colleagues at the Royal Infirmary of Edinburgh enlisted 152 cirrhotic patients with grade II or larger esophageal varices that had not bled in this study. Researchers treated 77 patients with carvedilol, a non-cardioselective beta-blocker (NSBB) marketed under the trade name Eucardic (Roche), while 75 patients underwent VBL every two weeks until eradication. Patients were administered carvedilol orally at a starting dose of 6.25 mg per day, increasing to a target dose of 12.5 mg per day.
Results showed 10% of patients receiving carvedilol and 23% of patients treated by VBL experienced variceal bleeding during the follow-up period. There was no difference in survival rates between the two groups. "The greater efficacy of carvedilol in the prevention of the first variceal bleed is an important finding of this study," said Dr. Tripathi. "No other randomized trial has demonstrated drug therapy to have an advantage over VBL."