Comparison of Carvedilol and Propranolol in the Treatment of Portal Hypertension in Cirrhosis
Introduction: Liver cirrhosis is the consequence of hepato-cellular injury that leads to both ﬁbrosis and nodular regeneration in the liver. It is the most common cause of portal hypertension and its morbidity and mortality is higher in our country. Objective: To compare the eﬃcacy of diﬀerent doses of carvedilol and propranolol for treatment of portal hypertension in patients of liver cirrhosis. This randomized clinical trial was conducted in the North Medical Ward, King Edward Medical University, Mayo Hospital, Lahore for 6 months i.e. March 2013 to August 2013. Methods: After ethical approval of the study, 100 conﬁrmed cases of liver cirrhosis with portal hypertension of ages 16 to 85 years with either gender were selected for this study by non-probability purposive sampling. These cases were randomly named as group A (I), A (II) & B (I), B (II). In group A (I) & (II) patients were given propanolol (20mg), Cavedilol (6.25mg) and group B (I) & (II) patients were given propranolol (40mg), carvedilol (12.5mg). Portal hypertension was labeled as portal ﬂow velocity >12cm HO/sec on Doppler 2 ultrasonography. Portal ﬂow velocity (PFV) was measured before and 90 minutes after administration of trial drugs and >20% decrease in portal ﬂow velocity from baseline was considered as eﬃcacy. Results: The mean age of the patients in group A was 48±14.4 years and in group B was 54 ±12.4 years. In group A (I), the mean portal ﬂow velocity at baseline was 22.16±4.28 cm HO/sec and after treatment at 90 2 minutes mean portal velocity was 18.12±4.14 cm HO/sec. In group A (II), the mean portal ﬂow velocity at 2 baseline was 25.16±4.2 and after treatment at 90 minute mean portal velocity was 13.16±2.42. In group B (I), the mean portal ﬂow velocity at baseline was 25.56±3.54 and after treatment at 90 minutes it was 13.96±3.5.In group B (II), the mean portal ﬂow velocity at baseline was 28.44±4.13 and In group B (I) after treatment at 90 minute mean portal velocity was 10.36±2.49. Conclusion: High dose carvedilol was more eﬀective than propranolol as well as low dose of carvedilol in reduction of PFV .
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