■与普萘洛尔相比,卡维地洛用于急性静脉曲张出血(AVB)后二级预防的临床结果比较信息有限。我们报告了一项随机对照试验的长期临床和安全性结果,该试验比较了卡维地洛与普萘洛尔在AVB术后患者肝静脉压力梯度(HVPG)降低方面的作用。
■我们对一项开放标签的随机对照试验招募的患者进行了事后分析,比较了卡维地洛和普萘洛尔在AVB治疗后,估计长期的再出血率,生存,额外的失代偿事件和安全性结果。使用竞争风险分析比较了再出血和其他代偿失调,把死亡作为竞争事件,使用Kaplan-Meier分析比较生存率。
■48例患者(25例服用卡维地洛;23例服用普萘洛尔)从随机分组开始随访6年。与服用普萘洛尔的患者相比,服用卡维地洛的患者有更多的HVPG反应(72%-卡维地洛与47.8%普萘洛尔相比,p=0.047)。获得了相当的1年和3年再出血率(卡维地洛分别为16.0%和24.0%,普萘洛尔分别为8.9%和36.7%;p=0.457)和生存率(卡维地洛分别为94.7%和89.0%,普萘洛尔分别为100.0%和79.8%;p=0.76)。在接受普萘洛尔的患者中,新的/恶化的腹水更为常见(69.5%vs40%;p=0.04)。两组之间的其他临床代偿失调和肝病并发症发生率相当。两组药物相关的不良事件相似。
■尽管HVPG响应程度更高,长期临床,在索引性静脉曲张出血后失代偿期肝硬化患者中,卡维地洛的生存和安全性结局与普萘洛尔相似,但卡维地洛患者的腹水发生率较低.
UNASSIGNED: There is limited information on comparison of clinical outcomes with carvedilol for secondary prophylaxis following acute variceal bleed (AVB) when compared with propranolol. We report long-term clinical and safety outcomes of a randomised controlled trial comparing carvedilol with propranolol with respect to reduction in hepatic venous pressure gradient (HVPG) in patients after AVB.
UNASSIGNED: We conducted a post-hoc analysis of patients recruited in an open-label randomized controlled trial comparing carvedilol and propranolol following AVB, and estimated long-term rates of rebleed, survival, additional decompensation events and safety outcomes. Rebleed and other decompensations were compared using competing risks analysis, taking death as competing event, and survival was compared using Kaplan-Meier analysis.
UNASSIGNED: Forty-eight patients (25 taking carvedilol; 23 propranolol) were followed up for 6 years from randomization. More number of patients on carvedilol had HVPG response when compared with those taking propranolol (72%- carvedilol versus 47.8% propranolol, p = 0.047). Comparable 1-year and 3-year rates of rebleed (16.0% and 24.0% for carvedilol versus 8.9% and 36.7% for propranolol; p = 0.457) and survival (94.7% and 89.0% for carvedilol versus 100.0% and 79.8% for propranolol; p = 0.76) were obtained. New/worsening ascites was more common in those receiving propranolol (69.5% vs 40%; p = 0.04). Other clinical decompensations and complications of liver disease occurred at comparable rates between two groups. Drug-related adverse-events were similar in both groups.
UNASSIGNED: Despite higher degree of HVPG response, long-term clinical, survival and safety outcomes in carvedilol are similar to those of propranolol in patients with decompensated cirrhosis after index variceal bleed with the exception of ascites that developed less frequently in patients with carvedilol.