Retrospective Analysis of Specific vs Non-specific Beta Blockers for Variceal Bleed

Abstract

Introduction: The most feared complication of cirrhosis is variceal bleeding with a high mortality (15 to 30%). Prophylactic treatment for variceal bleeds consists of treatment with nonselective beta blocker therapy (NSBB) or endoscopic variceal ligation. With reports of effective alternative BB therapy, this study aims to compare the efficacy of B2BB and NSBB therapy in cirrhotic patients with varices. Methods: An IRB approved retrospective study of 150 patients with cirrhotic patients with varices who were evaluated between 2003 and 2013 underwent chart review. One patient was excluded due to prior variceal bleed. The remaining 149 patients were evaluated from the initial EGD for subsequent bleeding, transplantation, or death. Medical therapy was evaluated. Descriptive statistics, Chi squared tests, and Kaplan-Meier Survival and Cox Regression curves were analyzed. Results: The population was 104/149 (69%) male with viral hepatitis the predominant cause of cirrhosis. 35 of 149 (24%) patients bled and 10 (6.7%) patients rebled. Other demographic data is shown in Table 1. Kaplan Meier analysis indicated no difference between individual BB therapy however results revealed Propranolol and No BB treatment had the longest time to bleed Figure 1 where as “other” treatment was significantly different from no treatment, Propranolol and Metoprolol p < 0.05 table 2. Cox regession analysis revealed Metoprolol and Propranolol had significant effects on the model for bleeding risk p < 0.05 and for death Metoprolol was also significant. Other significant factors were varix size, MELD, and diuretic use p < 0.05.Figure 1Table 1: Descriptive StatisticsTable 2: Pairwise Comparisons of BB therapiesConclusion: BB therapy for prevention of variceal bleeds has been shown to be effective in cirrhotic patients with high risk for variceal bleed. Our study aimed to try to address the role for B2BB. Our data revealed few statistical differences between BB therapies however suggested Metoprolol and Propranolol may play significant beneficial roles though with HR favoring the effect of propranolol. While not significant the trend suggests that propranolol may be the optimal BB. Current literature reveals similar findings favoring no BB treatment in the patients with low risk of bleed, while advantageous in patients with high bleeding risk. Further study is needed to elucidate the role of non selective BB within these populations.