Beta–Adrenergic Antagonists in the Prevention of Gastrointestinal Rebleeding in Patients With Cirrhosis: A Meta–Analysis

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A meta–analysis of 12 selected randomized trials was performed to assess the efficacy of beta–blockers in the prevention of rebleeding and the effect on long–term survival in patients with cirrhosis. Five end points were assessed: rebleeding, variceal rebleeding, death, death from bleeding, and adverse events. Analyses were performed according to the intention–to–treat method. For each end point, heterogeneity and treatment efficacy were assessed by the Der Simonian and Peto methods. When a significant difference was observed, sensitivity analyses were performed by successive stratifications according to treatment duration, cause of initial bleeding, use of placebo, type of beta–blocker, type of publication, certainty of randomization, severity of cirrhosis, interval between index bleed and randomization, and methodological quality. Beta–blockers significantly increased the mean percentage of patients free of rebleeding (21% mean improvement rate, CI 95%: 10%–32%, P < .001, relative risk 1.42), the mean percentage of patients free of variceal rebleeding (20% mean improvement rate, CI 95%: 11%–28%, P < .001), the mean survival rate (5.4% mean improvement rate, CI 95%: 0%–11%, P = .05, relative risk 1.27), the mean percentage of patients free of bleeding death (7.4%, CI 95%: 2%–13%, P < .01, relative risk 1.50). Five patients would need to be treated with beta–blockers to prevent one rebleeding episode, 14 treated to prevent one death, and 13 treated to prevent one death from bleeding. There was no significant heterogeneity among studies by both methods of analysis. In patients with esophageal varices, beta–blockers significantly increase the mean percentage of patients free of rebleeding and the mean survival rate at 2 years.