Non-selective β-adrenoceptor blockers in patients with decompensated liver disease
Editor – We read with great interest the excellent article ‘Drug therapies in liver disease’ by Collins et al (Clin Med December 2013 pp 585–91). However, the section regarding the use of β-blockers warrants further comment.
Although the use of non-selective β-adrenoceptor blockers is strongly supported in the use of primary and secondary prophylaxis of variceal bleeding,1 there has been some controversy with its use in patients with advanced cirrhosis. In a study by Serste et al,2 151 patients with Child Pugh C cirrhosis and refractory ascites were assessed. Seventy-seven patients were being treated with β-blockers and 74 were not. At 1 year, 19% of patients treated with β-blockers were alive, compared to 64% who were not (p < 0.0001). A follow-up study by the same group found that inpatients with refractory ascites and on β-blockers had a higher risk of paracentesis-induced circulatory dysfunction.
Admittedly the studies have flaws and robust randomised controlled trials are needed, but clinicians should be cautious when using these drugs in patients with advanced liver disease.
References
- 1.Tripathi D, Hayes PC. Beta-blockers in portal hypertension: new developments and controversies. Liver Int 2013;doi: 10.1111/liv.12360 [Epub ahead of print]. [DOI] [PubMed] [Google Scholar]
- 2.Sersté T, Melot C, Francoz C, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010;52:1017–22. 10.1002/hep.23775 [DOI] [PubMed] [Google Scholar]