The use of propranolol as primary prophylaxis in preventing an index bleed in patients with liver cirrhosis: a retrospective cohort study

Ruben Gregory Xavier, Mohamad Hafizzudin Mohame Tahir, Mohd Hafis Zulkifli, Winn Hui Han, Azmi Hassan


Background: Oesophageal varices are common in patients with liver cirrhosis. A proportion of them develop variceal bleeding which leads to significant morbidity and mortality. Primary prophylaxis has been recommended to prevent variceal bleeding. Endoscopic variceal ligation (EVL) and non-selective beta blockers (NSBBs) are two commonly used modalities in primary prophylaxis. However, EVL requires repeated procedures whereas NSBBs are equally effective and cost less. Our objective was to evaluate the effectiveness of propranolol as primary prophylaxis to prevent an index bleed in a secondary referral centre in West Pahang, Malaysia.
Methods: We retrospectively evaluated all patients who underwent surveillance upper endoscopy for liver cirrhosis from 1st January 2015 to 31st December 2016 in Hospital Sultan Haji Ahmad Shah (HoSHAS), Pahang, Malaysia. Patient demography, Child-Pugh score, endoscopic findings, whether EVL was done, propranolol administration and presence of any index bleed in 2 years were recorded and analysed using SPSS version 20.
Results: Sixty-nine patients had surveillance upper endoscopy for liver cirrhosis. Seven patients died of other causes unrelated to varices. About half the patients had EVL performed. Fifty-four patients (87.1%) received propranolol prophylaxis, of which 44 (81.5%) did not develop an index bleed in 2 years.
Conclusions: NSBBs is an effective method of primary prophylaxis in preventing index bleed for patients with liver cirrhosis, either as a stand-alone therapy or in combination with EVL, especially in a resource-limited centre.