Resumo

BOLANOS JACOME, Pablo Alexander et al. Efficacy of Carvedilol vs Propranolol in reducing hepatic gradient pressure in variceal bleeding prophylaxis: a systematic review and meta-analysis. Rev. Urug. Med. Int. [online]. 2026, vol.11, 201.  Epub 01-Dez-2026. ISSN 2393-6797.

We conducted a systematic review and meta-analysis, registered in PROSPERO (CRD420251118849) and reported per PRISMA, to compare the efficacy and safety of carvedilol versus propranolol for primary prophylaxis of variceal hemorrhage in cirrhosis. Randomized controlled trials were searched in MEDLINE/PubMed, Embase, and Cochrane CENTRAL through December 2024, including adults with varices without prior bleeding and ≥6 months’ follow-up. Seven studies met eligibility (six RCTs and one propensity-matched cohort; the latter was not meta-analyzed); three RCTs provided homogeneous data for quantitative synthesis of hemodynamic response (HVPG). Using a random-effects model, there was no significant difference between carvedilol and propranolol in the proportion of hemodynamic responders (risk difference 0.01; 95% CI −0.31 to 0.33; p=0.96), with substantial heterogeneity (I²=81%; p=0.005). Direct, consistent evidence on first variceal bleeding was limited and heterogeneous, without a conclusive signal of clinical superiority for either drug; overall safety profiles were comparable. The funnel plot showed no clear asymmetry, although interpretation was limited by the small number of studies per endpoint. Overall, available RCT evidence does not demonstrate statistically significant superiority of carvedilol over propranolol for primary prophylaxis; larger, blinded RCTs with adequate power for hard clinical outcomes and sufficient follow-up are warranted.

Palavras-chave : Carvedilol; Propranolol; Portal Hypertension.

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