Carvedilol vs endoscopic variceal ligation for primary and secondary prevention of variceal bleeding: Systematic review and metaanalysis

作     者：Michael Dwinata David Dwi Putera Muhamad Fajri Adda’i Putra Nur Hidayat Irsan Hasan 

作者机构：Department of Internal MedicineDepati Hamzah General HospitalPangkalpinang 33684Indonesia School of Medicine and Public HealthUniversity of SydneySydney 2006Australia Faculty of MedicinePublic Healthand NursingUniversitas Gadjah MadaYogyakarta 55281Indonesia Hepatobiliary DivisionDepartment of Internal MedicineFaculty of Medicine Universitas IndonesiaCipto Mangunkusumo National General HospitalJakarta 10430Indonesia 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第5期

页      面：464-476页

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Carvedilol Liver cirrhosis Variceal hemorrhage Portal hypertension Prophylaxis 

摘      要：BACKGROUND Variceal hemorrhage is associated with high mortality and is the cause of death for 20–30%of patients with ***βblockers(NSBBs)or endoscopic variceal ligation(EVL)are recommended for primary prevention of variceal bleeding in patients with medium to large esophageal ***,combination of EVL and NSBBs is the recommended approach for the secondary *** has greater efficacy than other NSBBs as it decreases intrahepatic *** hypothesized that there was no difference between carvedilol and EVL intervention for primary and secondary prevention of variceal bleeding in cirrhosis *** To evaluate the efficacy of carvedilol compared to EVL for primary and secondary prevention of variceal bleeding in cirrhotic patients METHODS We searched relevant literatures in major journal databases(CENTRAL,MEDLINE,and EMBASE)from March to August *** with cirrhosis and portal hypertension,regardless of aetiology and severity,with or without a history of variceal bleeding,and aged≥18 years old were included in this *** randomized controlled trials(RCTs)that compared the efficacy of carvedilol and that of EVL for primary and secondary prevention of variceal bleeding and mortality in patients with cirrhosis and portal hypertension were considered,irrespective of publication status,year of publication,and *** Seven RCTs were *** four trials assessing the primary prevention,no significant difference was found on the events of variceal bleeding(RR:0.74,95%CI:0.37-1.49),all-cause mortality(RR:1.10,95%CI:0.76-1.58),and bleedingrelated mortality(RR:1.02,95%CI:0.34-3.10)in patients who were treated with carvedilol compared to *** three trials assessing secondary prevention,there was no difference between two interventions for the incidence of rebleeding(RR:1.10,95%CI:0.75-1.61).The fixed-effect model showed that,compared to EVL,carvedilol decreased all-cause mortality by 49%(RR:0.51,95