Outcomes in Cirrhotic Patients with Variceal Bleeding Despite Primary Prophylaxis with a ?-Blocker

Even with the addition of endoscopic band ligation, such patients are at increased risk for recurrent bleeding and death.


Current guidelines recommend that patients with cirrhosis who have large varices but have not had an episode of variceal bleeding should receive primary prophylaxis with a nonselective ?-blocker. For individuals who experience an episode of variceal bleeding despite such therapy, the addition of endoscopic band ligation is recommended to prevent rebleeding, but little is known about long-term outcomes.

In a single-center cohort study, researchers in Spain analyzed data for consecutive patients with cirrhosis who were admitted with a first acute variceal bleeding episode. Among the 89 eligible patients, 34 were receiving primary prophylaxis with a nonselective ?-blocker (?-blocker group), and 55 were not (control group). All patients were subsequently treated with endoscopic band ligation and nonselective ?-blockers. Follow-up examinations occurred at 1, 3, and 6 months, then every 6 months until 2 years.

The incidence of variceal rebleeding was significantly higher in the ?-blocker group than in the control group (39% vs. 17%; P<0.01). In multivariate analysis, only primary prophylaxis with a nonselective ?-blocker (hazard ratio, 2.37; 95% confidence interval, 1.10–5.11) and increase in serum bilirubin level (for each mg/dL increase: HR, 1.13; 95% CI, 1.06–1.21) were independent predictors of rebleeding. The probability of transplant-free survival was lower for the ?-blocker group than for the control group (66% vs. 88%; P=0.02).


Citation(s):

de Souza AR et al. Patients whose first episode of bleeding occurs while taking a ?-blocker have high long-term risks of rebleeding and death. Clin Gastroenterol Hepatol 2012 Jun; 10:670.