article · Liver International
In adults with cirrhosis and portal hypertension who underwent variceal band ligation, the use of nonselective beta-blockers was evaluated to determine the risk of developing portal vein thrombosis. Analysis of a matched multi-institutional cohort of 4,296 patients per group revealed that overall nonselective beta-blocker use was linked to a higher incidence of portal vein thrombosis compared to no beta-blocker use, rising from 5.4 percent to 9.5 percent. However, outcomes differed substantially by the specific medication administered. Propranolol was associated with an elevated risk of portal vein thrombosis. In contrast, carvedilol did not increase the incidence of portal vein thrombosis relative to controls and was associated with significantly lower all-cause mortality compared with both propranolol and no beta-blocker therapy. Selecting specific beta-blockers can therefore meaningfully alter clinical outcomes in this patient group.
Portal vein thrombosis is a serious complication for individuals suffering from cirrhosis and portal hypertension. Because nonselective beta-blockers are a standard intervention after variceal band ligation, understanding their specific safety profiles is vital. Differentiating between the effects of propranolol and carvedilol can assist healthcare providers in reducing thrombosis risks while simultaneously improving overall patient survival rates during long-term clinical care.
These findings can inform clinical decision-making, hospital prescribing protocols, and commercial decision-support software used by hepatology specialists. Because this research is based on retrospective observational data from an existing electronic health records network, it represents applied clinical evidence rather than a standalone commercial product. Integrating these drug-specific risk insights into digital prescribing systems and clinical practice pathways is relatively close to practical real-world adoption.
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BACKGROUND: Portal vein thrombosis (PVT) is a significant complication of cirrhosis. Nonselective beta-blockers (NSBBs) are standard therapy for portal hypertension, but their effect on PVT risk remains uncertain. AIM: To assess whether NSBB use after variceal band ligation increases PVT risk and to compare outcomes among propranolol, carvedilol and no NSBB therapy. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (> 110 million patients). Adults with cirrhosis and portal hypertension who underwent variceal band ligation (2010-2024) were included. Patients were stratified by NSBB exposure and matched 1:1 on 12 clinical variables. The primary outcome was incident PVT; secondary outcome was all-cause mortality. Kaplan-Meier analysis evaluated time-to-event outcomes. RESULTS: After matching (n = 4296 per group), NSBB use was associated with higher PVT incidence compared with no NSBBs (9.5% vs. 5.4%; RR 1.765, 95% CI 1.500-2.077). Propranolol was associated with increased PVT risk, whereas carvedilol showed similar PVT incidence to controls and significantly lower mortality compared with both propranolol and no NSBB use. CONCLUSIONS: Propranolol use was linked to increased PVT risk, while carvedilol did not elevate PVT risk and was associated with improved survival. Beta-blocker selection may meaningfully influence outcomes in cirrhosis.
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DOI: 10.1111/liv.70843
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