Evidence map›Paper›PMID 31040627›Full record

ArticleAnnals of gastroenterology

Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis.

Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Evangelos Akriviadis, Apostolos Tsapas

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of gastroenterology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 31 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
  4. Review
  5. Cardiac Syndromes in Liver Disease: A Clinical Conundrum.Journal of clinical and translational hepatology · 2023
    Review
  6. CarvedilolJGH open : an open access journal of gastroenterology and hepatology · 2022
    Article
  7. Evaluation of liver transplant candidates with non-alcoholic steatohepatitis.Translational gastroenterology and hepatology · 2022
    Review
  8. Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Konstantinos MalandrisClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Paschalis PaschosClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Anastasia KatsoulaClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Apostolos ManolopoulosClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Panagiotis AndreadisClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Maria SarigianniClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Eleni AthanasiadouClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Evangelos AkriviadisFourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece (Evangelos Akriviadis).
Apostolos TsapasClinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece (Konstantinos Malandris, Paschalis Paschos, Anastasia Katsoula, Apostolos Manolopoulos, Panagiotis Andreadis, Maria Sarigianni, Eleni Athanasiadou, Apostolos Tsapas).
Aristotle University of Thessaloniki · GR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBeta-blockers are used for prophylaxis of variceal bleeding. Our aim was to assess the efficacy and safety of carvedilol for primary or secondary prevention of variceal bleeding in patients with cirrhosis.

methodsWe searched Medline, Embase, CENTRAL and gray literature sources for randomized controlled trials (RCTs) comparing carvedilol with placebo or any active intervention. We synthesized data using random effects models. We summarized the strength of evidence using GRADE criteria.

resultsWe included 13 trials with 1598 patients. Carvedilol was as efficacious as endoscopic variceal ligation (EVL) (4 RCTs, risk ratio [RR] 0.74, 95% confidence interval [CI] 0.37-1.49) or propranolol (3 RCTs, RR 0.76, 95%CI 0.27-2.14) for primary prevention of variceal bleeding. Likewise, carvedilol was as efficacious as EVL (3 RCTs, RR 1.10, 95%CI 0.75-1.61), non-selective beta-blockers (NSBBs) plus isosorbide-5-mononitrate (2 RCTs, RR 1.02, 95%CI 0.70-1.51) or propranolol (2 RCTs, RR 0.39, 95%CI 0.15-1.03) for secondary prevention of variceal bleeding. Carvedilol was associated with lower all-cause mortality compared to EVL (3 RCTs, RR 0.51, 95%CI 0.33-0.79). There was no difference in any other efficacy outcome. Finally, there were no significant differences in the safety profiles compared with EVL and NSBBs. Our confidence in the effect estimates for all outcomes was very low.

conclusionCarvedilol is as efficacious and safe as standard-of-care interventions for the primary and secondary prevention of variceal bleeding.

Indexed as

Carvedilolmeta-analysisvariceal bleeding

Identifiers

PMID31040627
PMCPMC6479656
OpenAlexW2921696470

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-SA
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.