Carvedilol for reducing portal pressure in primary prophylaxis of variceal bleeding: a dose-response study
Carvedilol for reducing portal pressure in primary prophylaxis of variceal bleeding: a dose-response study
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DOI：
10.1111/apt.14576
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发表时间：
2018-04-01
影响因子：
7.6
通讯作者：
Ferlitsch, A.
中科院分区：
文献类型：
--
作者：
Schwarzer, R.;Kivaranovic, D.;Ferlitsch, A.
工作背景：采用肝静脉压力梯度（HVPG）的连续测量来评估门静脉高压症患者对非选择性β受体阻滞剂（NSBB）的血流动力学反应。目的：评估HVPG对不同剂量卡维地洛的反应率。方法：2010年8月至2010年5月期间，接受HVPG指导的卡维地洛治疗作为静脉曲张出血一级预防的肝硬化连续性患者2015年被纳入回顾性研究。在基线HVPG测量后，给予卡维地洛6.25 mg/d，并且卡维地洛6.25 mg/d和卡维地洛12.5 mg/d分别有10例（14%）HVPG反应（HVPG-降低>= 20%或>= 10%或>= 20%）。卡维地洛6.25 mg/d组有40例（56%）患者HVPG降低≥ 10%，卡维地洛12.5 mg/d组有24例（33%）患者HVPG降低≥ 10%。因此，总体上，分别有38例（53%）和55例（76%）患者的HVPG反应>= 20%和>= 10%。值得注意的是，6例患者（n = 4例腹水）由于低血压/心动过缓而不能耐受增加至12.5 mg/d。结论：卡维地洛12.5mg/d比6.25mg/d降低HVPG的效果更好。卡维地洛12.5 mg/d治疗后，共有76%的患者HVPG反应>= 10%，但可能发生动脉低血压，尤其是在腹水患者中。
Background: Sequential measurements of hepatic venous pressure gradient (HVPG) are used to assess the haemodynamic response to nonselective betablockers (NSBBs) in patients with portal hypertension.Aims: To assess the rates of HVPG response to different doses of carvedilol.Methods: Consecutive patients with cirrhosis undergoing HVPG-guided carvedilol therapy for primary prophylaxis of variceal bleeding between 08/2010 and 05/2015 were retrospectively included. After baseline HVPG measurement, carvedilol 6.25 mg/d was administered and HVPG response (HVPG-decrease >= 20% or to = 10% or to = 20% with carvedilol 6.25 mg/d and another 10 (14%) with carvedilol 12.5 mg/d. Forty (56%) patients had a HVPG decrease >= 10% with carvedilol 6.25 mg/d and 24 (33%) with carvedilol 12.5 mg/d. Thus, in total, a HVPG-response of >= 20% and >= 10% and was achieved in 38 (53%) and 55 (76%) and of patients respectively. Notably, 6 patients (n = 4 with ascites) did not tolerate an increase to 12.5 mg/d due to hypotension/bradycardia. However, none of the other patients had a SAP < 90 mm Hg at the final HVPG measurement.Conclusion: Carvedilol 12.5 mg/d was more effective than 6.25 mg/d in decreasing HVPG in primary prophylaxis. A total of 76% of patients achieved a HVPG-response of >= 10% to carvedilol 12.5 mg/d, however, arterial hypotension might occur, especially in patients with ascites.