LAUSR

Introduction Carvedilol reduces rates of variceal bleeding and rebleeding by lowering portal pressure. However, an associated pleotropic survival benefit has been proposed. Methods The index study randomised 64 cirrhotic patients with clinically confirmed acute oesophageal variceal bleeding between June 2006 and December 2011 to receive either carvedilol or endoscopic band ligation (EBL).1 Long term follow-up was undertaken to April 2020. Results Of those randomised, 26/33 participants received carvedilol in the follow-up period and 28/31 attended for regular EBL sessions. There were no significant differences in baseline characteristics. Mean follow-up for all was 2217 days. The mean duration of carvedilol administration was 1267 days. On intention to treat analysis, there was a trend towards improved survival in the carvedilol group (p=0.09). On per-protocol analysis, carvedilol administration was significantly associated with improved long-term survival (p Conclusion Following an acute variceal bleed in cirrhotic patients, carvedilol is associated with survival benefit and fewer hospital admissions. Further studies are needed to validate this finding and explore the potential benefit in other patient groups. Reference Stanley AJ, Dickson S, Hayes PC, et al. Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding. J Hepatol. 2014;61(5):1014–1019.