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Hemodynamic rebound, variceal bleeding not seen after beta-blocker interruption in cirrhosis

In a prospective study, abrupt interruption of beta-blockers did not lead to hemodynamic rebound or increase the risk for variceal bleeding among patients with cirrhosis.

Researchers evaluated 249 consecutive patients with cirrhosis undergoing right heart catheterization with or without hepatic vein catheterization between June 2013 and March 2015. The final analysis comprised 150 patients. The researchers divided this cohort according to how many days beta-blockers were given before catheterization. Eighty-one patients did not receive beta-blockers, 44 received them within 1 day, 11 withdrew beta-blockers within 2 to 3 days before and 14 withdrew 4 or more days before catheterization, according to the research.

The median duration of beta-blockers interruption was 4 days among the patients who discontinued beta-blockers 2 days or more prior to catheterization. These patients experienced beta-blockers interruption due to myocardial stress testing as part of liver transplantation assessment (n = 22) or had decompensated liver disease with low blood pressure and/or impaired renal function (n = 3).

No gastrointestinal bleeding occurred in any of these patients during the period where beta-blockers was ceased or 1 month later.

“This contrasts with the idea that beta-blockers withdrawal causes variceal bleeding,” the researchers wrote.  

Hepatic venous pressure gradient was higher in patients usually treated with beta-blockers compared with patients who were not treated with them. However, this difference was only significant in patients who discontinued beta-blockers 4 days or more before catheterization. There was no difference in hepatic venous pressure gradient among the three groups of patients usually treated with beta-blockers.

After adjustment for covariates in multivariate linear regression analysis, beta-blockers interruption was not associated with hepatic venous pressure gradient. The cardiac index was greater in patients who withdrew beta-blockers 4 or more days before catheterization (4.6 L/min/m²) compared with patients who withdrew less than 1 day before (3.4 L/min/m²; P = .001) and between 2 and 3 days before (3.1 L/min/m²; P = .007). However, this did not differ from the patients who did not receive beta-blockers.

The researchers concluded: “Interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance during weaning.” – by Melinda Stevens

Disclosure: Payancé reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.