Abstract
Background and Aim: The risk and benefit of non-selective propranolol in patients with tense ascites are controversial. This study aimed to investigate the effect of propranolol as secondary prophylaxis on varix rebleeding and overall mortality in patients with tense ascites. Methods: This study used a database of the Health Insurance Review and Assessment Service (HIRAS), which provides health insurance to 97.2% of the total population in Korea. A total of 80,071 patients first variceal bleeding as the first decompensated complication enrolled from 2007 to 2014. Results: There were 2274 patients with large-volume ascites prescribed propranolol as secondary prophylaxis after first varix bleeding. The average prescription dose of propranolol as secondary prophylaxis was 74 mg/day in patients with large-volume ascites. The mean duration of rebleeding was 22.8 months. Result of analysis showed that low-dose propranolol (40–120 mg/day) compared to inadequate propranolol dose (<40 mg/day) as secondary prophylaxis decreased overall mortality and varix rebleeding in patients with tense ascites. Conclusions: Low-dose propranolol (40–120 mg/day) as secondary prophylaxis for variceal re-bleeding decreased overall mortality and varix rebleeding recurrence in patients with tense ascites.
Highlights
Variceal bleeding is a major complication of liver cirrhosis [1]
Most guidelines recommend the use of beta-blockers as secondary prophylaxis for variceal bleeding [6,7,8]
The inclusion criteria were as follows: (a) patients with variceal bleeding as the first complication and have not been treated for decompensated complications for the past 2 years; (b) patients treated with the beta-blocker propranolol for more than 30 days
Summary
Variceal bleeding is a major complication of liver cirrhosis [1]. Mortality rate within 6 weeks after the first occurrence of variceal bleeding is approximately 15–20% [2,3]. A landmark study by Serste in 2010 first reported that the use of NSBBs increases mortality rate in patients with large-volume ascites [9]. Other studies reported that NSBBs (at an average dosage of 48.9–80 mg) were relatively effective and safe in patients with large-volume ascites [11,12,13,14]. We used open data source, so the informed consent waived This is a retrospective cohort study using data from January 2007 to December 2014, as requested by the2H.2.eSatluthdyInDseusirgannce Review and Assessment Service. Informed consent was waived because of the retrospectiTvheisnaistuarereotfrotshpeescttiuvde yc.ohort study using data from January 2007 to December 2014, as requested by the Health Insurance Review and Assessment Service.
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