Comparative Risk of Recurrent Esophageal Variceal Hemorrhage and Other Decompensation Events with Carvedilol Versus Propranolol in Patients with Cirrhosis: A Retrospective Study

Department

Internal Medicine

Document Type

Article

Publication Title

Digestive Diseases and Sciences

Abstract

Background & aims: Non-selective beta-blockers (NSBBs) have become a cornerstone treatment to prevent complications of cirrhosis and portal hypertension. Data supporting the use of a specific beta-blocker are scarce. In this retrospective study, we aimed to compare the effectiveness of carvedilol versus propranolol in: 1) preventing recurrent esophageal hemorrhage (EVH) in patients with prior history of EVH 2) reducing the occurrence of further decompensation episodes in these patients including hepatic encephalopathy (HE), ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), and hepatocellular carcinoma (HCC), and 3) reducing all-cause mortality.

Approach & results: This was a retrospective propensity-matched study using the multi-institutional database TriNetX. We included patients with cirrhosis who had an episode of EVH and were prescribed carvedilol or propranolol between December 2004 and December 2024. The primary outcome was the rate of hospitalization with recurrent EVH within the first 5 years of starting the index NSBB. The secondary outcomes were hospitalization with the principal diagnoses of ascites, SBP, HE, HRS, new diagnosis of HCC, undergoing liver transplant (LT), and all-cause mortality within the observation period of 5 years of NSBB prescription. Kaplan-Meier survival analysis was also performed. Compared to propranolol use, carvedilol use was associated with lower risk of EVH (RR, 0.898, P < 0.001), ascites (RR, 0.757, P < 0.001), SBP (RR, 0.680, P < 0.001), HRS (RR, 0.734, P < 0.001), HCC (RR, 0.701, P < 0.001), undergoing LT (RR, 0.825, P = 0.028) and mortality (RR, 0.640, P < 0.001). No difference in HE rates (RR, 0.899, P = 0.071) was found between the two groups.

Conclusions: Compared to propranolol, the use of carvedilol in patients with history of cirrhosis and EVH was associated with lower risk of recurrent EVH, further decompensation episodes, undergoing LT, and mortality.

First Page

1556

Last Page

1568

DOI

10.1007/s10620-025-09453-6

Volume

71

Issue

4

Publication Date

4-1-2026

Publisher

Springer Science + Business Media

Medical Subject Headings

Humans; Carvedilol; Propranolol; Male; Retrospective Studies; Female; Liver Cirrhosis; Esophageal and Gastric Varices; Middle Aged; Gastrointestinal Hemorrhage; Adrenergic beta-Antagonists; Aged; Recurrence; Treatment Outcome; Hepatic Encephalopathy

PubMed ID

41108335

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