Low-Dose Carvedilol for Primary Prophylaxis of Variceal Bleeding

Previous trials demonstrate that carvedilol, a nonselective beta-blocker with additional anti–alpha₁-adrenergic activity, is more effective than propranolol in reducing portal pressure (Hepatology 2002; 36:1367) and more effective than endoscopic band ligation in preventing a first variceal bleeding episode (Hepatology 2009; 50:825) in patients with cirrhosis. However, the typical fixed daily dose of ≥12.5 mg is associated with arterial hypotension, making its long-term use questionable. Also, its efficacy in patients who do not respond to propranolol is unknown.

To investigate further, researchers evaluated hemodynamic response to treatment with carvedilol for primary prophylaxis of variceal bleeding after nonresponse to propranolol in 104 …