{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T20:32:51Z","timestamp":1794515571999,"version":"4.9.1"},"reference-count":27,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Gut"],"accepted":{"date-parts":[[2012,11,23]]},"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Non-selective \u03b2-blockers or endoscopic band ligation (EBL) are recommended for primary prophylaxis of variceal bleeding in patients with oesophageal varices. Additional \u03b1-adrenergic blockade (as by carvedilol) may increase the number of patients with haemodynamic response (reduction in hepatic venous pressure gradient (HVPG) of \u226520% or to values &lt;12\u2005mm\u2005Hg).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Patients with oesophageal varices undergoing measurement of HVPG before and under propranolol treatment (80\u2013160\u2005mg\/day) were included. HVPG responders were kept on propranolol (PROP group), while non-responders were placed on carvedilol (6.25\u201350\u2005mg\/day). Carvedilol responders continued treatment (CARV group), while non-responders to carvedilol underwent EBL. The primary aim was to assess haemodynamic response rates to carvedilol in propranolol non-responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>36% (37\/104) of patients showed a HVPG response to propranolol. Among the propranolol non-responders 56% (38\/67) eventually achieved a haemodynamic response with carvedilol, while 44% (29\/67) patients were finally treated with EBL. The decrease in HVPG was significantly greater with carvedilol (median 12.5\u2005mg\/day) than with propranolol (median 100\u2005mg\/day): \u221219\u00b110% versus \u221212\u00b111% (p&lt;0.001). During a 2\u2005year follow-up bleeding rates for PROP were 11% versus CARV 5% versus EBL 25% (p=0.0429). Fewer episodes of hepatic decompensation (PROP 38%\/CARV 26% vs EBL 55%; p=0.0789) and significantly lower mortality (PROP 14%\/CARV 11% vs EBL 31%; p=0.0455) were observed in haemodynamic responders compared to the EBL group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Carvedilol leads to a significantly greater decrease in HVPG than propranolol. Using carvedilol for primary prophylaxis a substantial proportion of non-responders to propranolol can achieve a haemodynamic response, which is associated with improved outcome with regard to prevention of variceal bleeding, hepatic decompensation and death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gutjnl-2012-304038","type":"journal-article","created":{"date-parts":[[2012,12,18]],"date-time":"2012-12-18T20:35:45Z","timestamp":1355862945000},"page":"1634-1641","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":294,"title":["Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol"],"prefix":"10.1136","volume":"62","author":[{"given":"Thomas","family":"Reiberger","sequence":"first","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Ulbrich","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine I, Hospital Hietzing, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnulf","family":"Ferlitsch","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berit Anna","family":"Payer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schwabl","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Pinter","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit B","family":"Heinisch","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig","family":"Kramer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine I, Hospital Hietzing, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Peck-Radosavljevic","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Vienna Hepatic Hemodynamic Lab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2012,12,18]]},"reference":[{"key":"2025090713215380000_62.11.1634.1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0168-8278(00)80422-5","article-title":"Complications of cirrhotic. 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