Efficacy of propranolol versus carvedilol in prophylaxis of variceal bleeding: Randomized clinical trial.

Objective: To compare the efficacy of carvedilol and propranolol for prophylaxis of variceal bleeding in cirrhotic patients. Study Design: Randomized Controlled Trial. Setting: Department of Gastroenterology and Hepatology, PIMS, Islamabad. Period: 1st January 2022 to 31st of December 2022. Material & Methods: A total of 260 patients reporting at the department suffering from liver cirrhosis with medium or large esophageal varices and had never reported for variceal bleeding previously. The patients were randomized in to 2 equal groups of 130 each through computer generated randomization. Patients in Group-A were started on dose of carvedilol 6.25mg once daily initially for 1 week, subsequently titrated to twice daily 6.25mg and titrated up if needed to maximum of 25mg twice daily. Patients in Group-B received a dosage of propranolol 20 mg BID which then escalated weekly in 20 mg steps if needed and doses were adjusted as per targeted heart rate and systolic BP. Patients were followed up over 1 year for any event of variceal bleeding. Results: Mean overall age in this study was 42.13±10 years. The ratio of male patients was higher than female patients (60% VS 40%). Carvedilol prevented variceal bleeding in 86.15% of the patients while propranolol was effective in preventing variceal bleeding in 75.38% of the patients. Hence carvedilol was significantly more effective than propranolol in preventing variceal bleeding (p=0.02). Conclusion: Carvedilol is significantly more effective in prophylaxis of variceal bleeding than propranolol in patients with medium or large esophageal varices.