The quality of evidence is downgraded by study limitations and imprecise results.
A Cochrane review [Abstract] 1 included 10 studies with a total of 810 subjects. Included were randomised clinical trials comparing carvedilol versus traditional, non-selective beta-blockers evaluating both primary and secondary prevention of upper gastrointestinal bleeding in adults with cirrhosis and verified gastroesophageal varices. The intervention comparisons were carvedilol versus propranolol (nine trials), or nadolol (one trial). Six trials were of short duration (mean 6 [range 1 to 12] weeks), while four were of longer duration (13.5 [6 to 30] months). Three trials evaluated primary prevention; three evaluated secondary prevention; while four evaluated both primary and secondary prevention.
Sixteen of 254 participants receiving carvedilol and 19 of 253 participants receiving propranolol or nadolol died (RR 0.86, 95% CI 0.48 to 1.53). There appeared to be no differences between carvedilol versus traditional, non-selective beta-blockers and the risks of upper gastrointestinal bleeding (RR 0.77, 95% CI 0.43 to 1.37; 810 participants; 10 trials) and serious adverse events (RR 0.97, 95% CI 0.67 to 1.42; 810 participants; 10 trials). Significantly more deaths, episodes of upper gastrointestinal bleeding and serious adverse events occurred in the long-term trials but there was not enough information to determine whether there were differences between carvedilol and traditional, non-selective beta-blockers, by trial duration. There was also insufficient information to detect differences in the effects of these interventions in trials evaluating primary or secondary prevention.
SOF table http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011510.pub2/full#CD011510-sec-0029
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