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After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis?
BACKGROUND/AIMS: Literature regarding safe doses of carvedilol is limited, and safe doses across different Child classes of chronic liver disease are not clear. PATIENTS AND METHODS: A total of 102 consecutive cirrhotic patients with significant portal hypertension were included in this study. Hepat...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632251/ https://www.ncbi.nlm.nih.gov/pubmed/26458853 http://dx.doi.org/10.4103/1319-3767.164207 |
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author | Wani, Zeeshan A. Baht, Riyaz A. Bhadoria, Ajeet S. Maiwall, Rakhi Majeed, Yamin Khan, Afaq A. Zargar, Showkat A. Shah, Mohd A. Khan, Kaiser M. |
author_facet | Wani, Zeeshan A. Baht, Riyaz A. Bhadoria, Ajeet S. Maiwall, Rakhi Majeed, Yamin Khan, Afaq A. Zargar, Showkat A. Shah, Mohd A. Khan, Kaiser M. |
author_sort | Wani, Zeeshan A. |
collection | PubMed |
description | BACKGROUND/AIMS: Literature regarding safe doses of carvedilol is limited, and safe doses across different Child classes of chronic liver disease are not clear. PATIENTS AND METHODS: A total of 102 consecutive cirrhotic patients with significant portal hypertension were included in this study. Hepatic venous pressure gradient was measured at baseline and 3 months after dose optimization. RESULTS: A total of 102 patients (63 males, 39 females) with a mean age of 58.3 ± 6.6 years were included. Among these patients, 42.2% had Child Class A, 31.9% had Class B, and 26.6% had Child Class C liver disease. The mean baseline hepatic venous pressure gradient was 16.75 ± 2.12 mmHg, and after dose optimization and reassessment of hepatic venous pressure gradient at 3 months, the mean reduction in the hepatic venous pressure gradient was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and nonresponders respectively. The mean dose of carvedilol was higher in nonresponders (19.2 ± 5.7 mg) than responders (18.75 ± 5.1 mg). However, this difference was not statistically significant (P > 0.05). The univariate analysis determined that the absence of adverse events, the absence of ascites, and low baseline cardiac output were significantly associated with chronic response, whereas, the etiology, Child class, variceal size (large vs small), and gender were not. On multivariate analysis, the absence of any adverse event was determined to be an independent predictor of chronic response (OR 11.3, 95% CI; 1.9–67.8). CONCLUSION: The proper optimization of the dose of carvedilol, when administered chronically, may enable carvedilol treatment to achieve a greater response with minimum side effects among different Child classes of liver disease. |
format | Online Article Text |
id | pubmed-4632251 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-46322512015-11-24 After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? Wani, Zeeshan A. Baht, Riyaz A. Bhadoria, Ajeet S. Maiwall, Rakhi Majeed, Yamin Khan, Afaq A. Zargar, Showkat A. Shah, Mohd A. Khan, Kaiser M. Saudi J Gastroenterol Original Article BACKGROUND/AIMS: Literature regarding safe doses of carvedilol is limited, and safe doses across different Child classes of chronic liver disease are not clear. PATIENTS AND METHODS: A total of 102 consecutive cirrhotic patients with significant portal hypertension were included in this study. Hepatic venous pressure gradient was measured at baseline and 3 months after dose optimization. RESULTS: A total of 102 patients (63 males, 39 females) with a mean age of 58.3 ± 6.6 years were included. Among these patients, 42.2% had Child Class A, 31.9% had Class B, and 26.6% had Child Class C liver disease. The mean baseline hepatic venous pressure gradient was 16.75 ± 2.12 mmHg, and after dose optimization and reassessment of hepatic venous pressure gradient at 3 months, the mean reduction in the hepatic venous pressure gradient was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and nonresponders respectively. The mean dose of carvedilol was higher in nonresponders (19.2 ± 5.7 mg) than responders (18.75 ± 5.1 mg). However, this difference was not statistically significant (P > 0.05). The univariate analysis determined that the absence of adverse events, the absence of ascites, and low baseline cardiac output were significantly associated with chronic response, whereas, the etiology, Child class, variceal size (large vs small), and gender were not. On multivariate analysis, the absence of any adverse event was determined to be an independent predictor of chronic response (OR 11.3, 95% CI; 1.9–67.8). CONCLUSION: The proper optimization of the dose of carvedilol, when administered chronically, may enable carvedilol treatment to achieve a greater response with minimum side effects among different Child classes of liver disease. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4632251/ /pubmed/26458853 http://dx.doi.org/10.4103/1319-3767.164207 Text en Copyright: © 2015 Saudi Journal of Gastroenterology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Wani, Zeeshan A. Baht, Riyaz A. Bhadoria, Ajeet S. Maiwall, Rakhi Majeed, Yamin Khan, Afaq A. Zargar, Showkat A. Shah, Mohd A. Khan, Kaiser M. After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title | After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title_full | After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title_fullStr | After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title_full_unstemmed | After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title_short | After Proper Optimization of Carvedilol dose, do Different Child Classes of Liver Disease Differ in Terms of dose Tolerance and Response on a Chronic Basis? |
title_sort | after proper optimization of carvedilol dose, do different child classes of liver disease differ in terms of dose tolerance and response on a chronic basis? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632251/ https://www.ncbi.nlm.nih.gov/pubmed/26458853 http://dx.doi.org/10.4103/1319-3767.164207 |
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