Effective Dose of Propranolol for Primary and Secondary Prophylaxis of Variceal Hemorrhage in Cirrhosis

Abstract

Background:

The variability in propranolol dose significantly impacts its effectiveness in preventing variceal hemorrhage (VH) in cirrhotic patients. This study aimed to determine an effective prophylactic dose of propranolol for both primary and secondary VH prophylaxis to optimizing treatment.

Methods:

A retrospective study was conducted on cirrhotic patients treated with propranolol for primary and secondary VH prophylaxis from 2008 to 2023. Patients were categorized into two groups: those receiving ≥80 mg/day and those receiving <80 mg/day. The primary outcome was VH incidence. A multivariable Cox-proportional hazard model with propensity score-inverse probability of treatment weighting (PS-IPTW) was used to assess the association between propranolol dose and VH incidence.

Results:

Of 215 patients on primary prophylaxis, 104 (48.4%) received propranolol ≥80 mg/day and 111 (51.6%) propranolol <80 mg/day. In secondary prophylaxis, 157 patients were included, with 83 (52.9%) of propranolol ≥80 mg/day group and 74 (47.1%) of propranolol <80 mg/day group. In the PS-IPTW Cox-proportional hazard model, the propranolol dose of ≥80 mg/day was significantly associated with reduced VH incidence for both primary and secondary prophylaxis. The adjusted hazard ratio (HR) was 0.37 (95%CI; 0.17-0.81, P = 0.01) for primary prophylaxis, and the adjusted HR was 0.51 (95%CI; 0.27-0.96, P = 0.04) for secondary prophylaxis.

Conclusion:

Achieving ≥80 mg/day of propranolol is associated with significantly reduced VH incidence in both primary and secondary prophylaxis in patients with cirrhosis. This dose should be considered as the target dose for enhancing the effectiveness of propranolol on VH prophylaxis.