Comparison of carvedilol and propranolol for primary prophylaxis of esophageal variceal bleed in cirrhotic patients.

Cirrhosis continues to claim the lives of people worldwide every year. Esophageal variceal bleeding due to portal hypertension is one of the dreadful complications. We compared carvedilol with propranolol to find better drug that can prevent index variceal bleed in cirrhotic patients. 220 patients with known esophageal varices on upper GI endoscopy and no previous history of GI bleed were randomized to group A (Carvedilol) and group B (Propranolol). Bleeding occurred in 37.14% and 59.04% of the patients in group A (carvedilol) and B (propranolol) respectively (p=0.02). Bleeding was more common among patients with large as compared to small varices (67.04% versus 35.48% respectively). Among patients with large varices bleeding occurred in 58.13% and 75.55% of patients in group A and B respectively while in small varices, bleeding rate was 25% and 46.66% respectively (p=0.03). Regarding the response of beta blockers, mean pulse rate dropped from 85.15±5.49 to 59.8±2.39 per minute in Group A while in Group B it was reduced to 60.5±4.21 from 83.8±5.33 per minute at 3 years follow up. No significant difference found in the side effect profile. Our study showed that carvedilol was more effective than propranolol in primary prevention of variceal hemorrhage.