Cirrhosis and Ascites Care in 2025 and Beyond

Although we’ve long prescribed β-blockers to patients with bleeding varices or known high-grade varices, whether we should start these agents earlier — as soon as patients with cirrhosis develop new-onset ascites (see Figure 1) — has been unclear. In 2025, a small randomized trial of carvedilol (vs. no carvedilol) in patients with cirrhosis and new-onset ascites (and with low-risk or no varices) showed that patients who received carvedilol had significantly fewer episodes of hepatorenal syndrome, spontaneous bacterial peritonitis, and refractory ascites (numbers needed to treat, 4 to 7 for each); required fewer large-volume paracenteses (NNT, 3); and were less likely to have died (9% vs. 24%; NNT, 6) at 1-year follow-up. These compelling re…