IDDF2020-ABS-0047 Clinical use of non-selective beta-blockers in unselected cirrhotic patients receiving endoscopic secondary prophylaxis

Background The combination of non-selective beta-blockers (NSBBs) and endoscopic band ligation has been recommended as the first-line therapy for preventing variceal rebleeding. However, little is known about the routine clinical use of this medication. We aimed to investigate the current situation of NSBBs use in respect of prevalence, tolerance and compliance in this study, and compare with that of endoscopic therapy. Methods We prospectively recruited cirrhotic patients undergoing secondary prophylaxis in our department from May 2019 to Jan 2020. Relevant medical and endoscopic data were collected. Bedside interviews were carried out using the specifically designed questionnaire. Therapy compliance was also assessed during the 6-month follow-up after initial therapy. Univariate and multivariate logistic regression were performed to explore the factors associated with therapy compliance. Results A total of 269 consecutive patients were screened, and 259 of them were included. Main etiologies of cirrhosis were hepatitis B/C (72.2%) and alcohol consumption (10.0%). Fifty-two (20.1%) patients were on the treatment of NSBBs and 53 (20.5%) patients were treated with NSBBs before, whereas 23 patients (8.9%) were with contraindications. Thirteen patients (25.0%) achieved hemodynamic response and the target dose was 32.1 mg/d for propranolol and 12.5 mg/d for carvedilol respectively. Overall adverse effects (AEs) were substantially more prevalent in endoscopic therapy than in NSBBs therapy (61.4% vs 25.7%, P Conclusions Clinical use of NSBBs for cirrhotic patients is far from optimal considering the low prevalence and high proportion of ineffective low-dose. NSBBs medication bears a higher rate of severe AEs compared with endoscopic therapy. Therapy compliance of both NSBBs and endoscopy are unsatisfactory, and optimized follow-up management is greatly needed.