Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis.
BMJ Open
; 6(5): e010902, 2016 05 04.
Article
in En
| MEDLINE
| ID: mdl-27147389
ABSTRACT
OBJECTIVE:
To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension.DESIGN:
A systematic review and meta-analysis. DATA SOURCES We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015. Only randomised controlled trials (RCTs) were included. OUTCOMEMEASURE:
We calculated clinical outcomes (all-cause mortality, bleeding-related mortality, upper gastrointestinal bleeding) as well as haemodynamic outcomes (hepatic venous pressure (HVPG) reduction, haemodynamic response rate, post-treatment arterial blood pressure (mean arterial pressure; MAP) and adverse events).RESULTS:
12 RCTs were included. In 7 trials that looked at haemodynamic outcomes compared carvedilol versus propranolol, showing that carvedilol was associated with a greater reduction (%) of HVPG within 6â months (mean difference -8.49, 95% CI -12.36 to -4.63) without a greater reduction in MAP than propranolol. In 3 trials investigating differences in clinical outcomes between carvedilol versus endoscopic variceal band ligation (EVL), no significant differences in mortality or variceal bleeding were demonstrated. 1 trial compared clinical outcomes between carvedilol versus nadolol plus isosorbide-5-mononitrate (ISMN), and showed that no significant difference in mortality or bleeding had been found. 1 trial comparing carvedilol versus nebivolol showed a greater reduction in HVPG after 14â days follow-up in the carvedilol group.CONCLUSIONS:
Carvedilol may be more effective in decreasing HVPG than propranolol or nebivolol and it may be as effective as EVL or nadolol plus ISMN in preventing variceal bleeding. However, the overall quality of evidence is low. Further large-scale randomised studies are required before we can make firm conclusions. TRIAL REGISTRATION NUMBER CRD42015020542.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Propanolamines
/
Propranolol
/
Carbazoles
/
Esophageal and Gastric Varices
/
Hemodynamics
/
Gastrointestinal Hemorrhage
/
Hypertension, Portal
/
Liver Cirrhosis
/
Antihypertensive Agents
Type of study:
Clinical_trials
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
BMJ Open
Year:
2016
Document type:
Article
Affiliation country:
China