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Primary prevention of esophageal variceal bleeding includes either variceal band ligation (VBL) or nonselective β-blockers. Carvedilol is the preferred nonselective β-blocker, due to its established efficacy in lowering portal pressure and improving patient outcomes. In this multicenter U.K. trial, 265 patients with cirrhosis and medium-to-large varices without prior bleeding were randomized to receive either carvedilol (12.5 mg once daily) or VBL.
After 1 year, the primary outcome of variceal bleeding was not significantly different with carvedilol or VBL (4% vs. 8%; P=0.18). Carvedilol dosage was reduced for 20% of patients, mainly due to dizziness or lethargy; however, no serious safety concerns were reported with carvedilol. A cost-effec…