Non-selective Beta-Blockers in Decompensated Cirrhosis

Abstract

Purpose of Review

The safety of non-selective beta-blockers (NSBB) in decompensated cirrhosis, particularly in patients with refractory ascites, has recently been called int question. This review summarizes recent evidence on the role of NSBBs in decompensated cirrhosis and provides recommendations for their appropriate use.

Recent Findings

Current evidence on the use of NSBBs in decompensated cirrhosis is mixed and is based on observational data. An initial study in 2010 demonstrated decreased survival in patients with refractory ascites who received propranolol compared to those who did not. Since then, multiple subsequent studies have not demonstrated a harmful effect of NSBBs in this setting. The safety of NSBB use is mediated by its dose, the type of NSBB, and the presence of underlying hemodynamic derangements related to end-stage cirrhosis.

Summary

Refractory ascites per se is not a contraindication to NSBB use. NSBBs can be safely used in decompensated cirrhosis, though the decision to do so requires careful decision making on the risk and benefit profile of NSBBs for each individual patient.

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Data Availability

All studies cited in this manuscript are available on PubMed.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Annsa Huang performed the literature review and prepared the primary manuscript draft. James Gardner created the original figures. Bilal Hameed provided content review and critically revised the final manuscript.

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Correspondence to Bilal Hameed.

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Bilal Hameed has grants from Gilead, Conatus, Intercept, Genfit, and Salix/Valeant. He also is on the advisory board for Gilead and Surrozen. The other authors declare that they have no conflicts of interest.

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Huang, A.C., Gardner, J.M. & Hameed, B. Non-selective Beta-Blockers in Decompensated Cirrhosis. Curr Hepatology Rep (2020). https://doi.org/10.1007/s11901-020-00529-7

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Keywords

  • Beta-blockers
  • Decompensated cirrhosis
  • Refractory ascites
  • Mortality
  • Complications
  • Portal hypertension