Long-Term Outcomes of Carvedilol Plus Endoscopic Variceal Ligation in Secondary Prophylaxis of Variceal Bleeding.

Abstract

Background: Carvedilol is key for primary prophylaxis of high-risk variceal bleeding but is less studied for secondary prophylaxis with EVL. This study compares the long-term outcomes of carvedilol plus EVL versus propranolol plus EVL in secondary prophylaxis.

Methods: The long-term follow-up data regarding rebleeding, ascites recurrence, and survival of patients who were treated with EVL plus carvedilol (n = 147) or propranolol (n = 53) for secondary prophylaxis of variceal bleeding were compared.

Results: Patients in the carvedilol group (n = 147) exhibited lower rebleeding rates (23.8% vs. 47.2%; hazard ratio(HR): 1.844; 95% confidence interval (CI) 1.099-3.096; p = 0.019) and ascites rates (7.5% vs. 30.2%; HR: 2.975; 95% CI 1.349-6.557; p = 0.003) compared to the propranolol group (n = 53). Cumulative mortality rates were similar between groups (12.2% vs. 30.2%; HR: 1.292; 95% CI 0.632-2.642; p = 0.48). In patients with viral cirrhosis, carvedilol resulted in lower rebleeding rates (HR: 2.236; 95% CI 1.188-4.208; p = 0.013) and improved ascites control (HR: 3.698; 95% CI 1.363-10.032; p = 0.010). Adjusted survival curves and 1:1 propensity score matching analyses confirmed these findings.

Conclusions: Our findings suggest that carvedilol combined with EVL may reduce rebleeding and ascites recurrence compared to propranolol in patients with cirrhosis, particularly those with viral etiologies. However, the lack of mortality benefit and limited generalizability to non-viral cirrhosis necessitate further validation in prospective trials.