Kerry Wilbur1, Kirhan Sidhu. 1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. kwilbur@interchange.ubc.ca
Abstract
GOALS: To characterize beta blocker therapy for the primary and secondary prevention of variceal hemorrhage. BACKGROUND: Variceal hemorrhage is one of the more frequent and severe complications of portal hypertension due to liver disease. Beta blocker therapy has been demonstrated to decrease risk of first bleed in patients with evidence of varices and recurrent bleeding and mortality in patients with history of prior variceal hemorrhage. STUDY: A total of 106 patients with liver disease hospitalized with suspected variceal hemorrhage were retrospectively reviewed. RESULTS: Half of patients had known varices, 44 (41.5%) of whom had experienced prior variceal hemorrhage. Only 21 (20%) were receiving beta blocker therapy at admission and 41 (48%) at discharge. The majority were not receiving therapy for primary prophylaxis (94%). Specific characteristics associated with beta blocker use could not be identified, although more patients with history of greater than two variceal hemorrhages were receiving beta blocker at admission (73% vs. 41%, P = 0.04) CONCLUSIONS: This study suggests that liver disease patients with varices are often not receiving beta blocker therapy to reduce risk of first or subsequent variceal hemorrhage. Opportunity exists to optimize use of this proven prophylactic treatment and bridge an apparent gap in standard of care.
GOALS: To characterize beta blocker therapy for the primary and secondary prevention of variceal hemorrhage. BACKGROUND: Variceal hemorrhage is one of the more frequent and severe complications of portal hypertension due to liver disease. Beta blocker therapy has been demonstrated to decrease risk of first bleed in patients with evidence of varices and recurrent bleeding and mortality in patients with history of prior variceal hemorrhage. STUDY: A total of 106 patients with liver disease hospitalized with suspected variceal hemorrhage were retrospectively reviewed. RESULTS: Half of patients had known varices, 44 (41.5%) of whom had experienced prior variceal hemorrhage. Only 21 (20%) were receiving beta blocker therapy at admission and 41 (48%) at discharge. The majority were not receiving therapy for primary prophylaxis (94%). Specific characteristics associated with beta blocker use could not be identified, although more patients with history of greater than two variceal hemorrhages were receiving beta blocker at admission (73% vs. 41%, P = 0.04) CONCLUSIONS: This study suggests that liver diseasepatients with varices are often not receiving beta blocker therapy to reduce risk of first or subsequent variceal hemorrhage. Opportunity exists to optimize use of this proven prophylactic treatment and bridge an apparent gap in standard of care.
Authors: Fasiha Kanwal; Tuyen Hoang; Jennifer R Kramer; Steven M Asch; Matthew Bidwell Goetz; Angelique Zeringue; Peter Richardson; Hashem B El-Serag Journal: Gastroenterology Date: 2010-12-22 Impact factor: 22.682
Authors: Rodney Steadman; Robert P Myers; Laura Leggett; Diane Lorenzetti; Tom Noseworthy; Sarah Rose; Lloyd Sutherland; Fiona Clement Journal: Can J Gastroenterol Date: 2013-03 Impact factor: 3.522