Epidemiology

Beta-blockers make paracentesis riskier in cirrhosis patients

Last Updated: 2011-03-22 19:11:01 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - In cirrhotic patients, beta blockers can increase the risk that paracentesis for ascites will cause circulatory dysfunction, French and Belgian researchers suggest.

Alternative therapies have not been examined but senior author Dr. Didier Lebrec told Reuters Health by email that his exploratory study suggests that "beta-blockers should be contraindicated" in cases of diuretic-resistant ascites.

Patients with cirrhosis and portal hypertension often receive non-selective beta-blockers to prevent gastrointestinal hemorrhage. But in a previous observational study, Dr. Lebrec of Centre de Recherche Biomedicale Bichat Beaujon, Paris, and colleagues found that beta blockers were linked with poor survival.

In that earlier study, the probability of survival at 1 year was 19% in patients who received propranolol compared to 64% in those who did not.

To investigate further, the researchers conducted a crossover study in 10 patients who'd needed paracentesis at least twice a month for 3 months. As reported online February 25th in the Journal of Hepatology, the research team assessed subjects twice: first while they were receiving propranolol (at doses ranging from 40 to 160 mg/day) and then again after beta-blockers had been stopped.

In all cases, ascites was replaced by albumin infusion.

With beta-blockers, the heart rate did not change immediately after paracentesis, and mean arterial pressure significantly decreased. Circulatory dysfunction - defined as an increase in plasma renin concentration of at least 50% above baseline a week after paracentesis - developed in eight patients.

After beta-blockers were discontinued, the heart rate significantly increased immediately after paracentesis and mean arterial pressure significantly decreased. Paracentesis-related circulatory dysfunction developed in only one patient.

The authors can't explain their findings. They say the only known predictive factors for this effect of paracentesis are the volume of ascites removed and the type of plasma expander, but these did not differ in their study.

Dr. Lebrec and his team call for caution, given the unanswered questions about the underlying mechanism and the very small size of the study. At this point, they conclude only that "beta-blockers may play a role in the development of paracentesis-induced circulatory dysfunction."

SOURCE: http://bit.ly/dUPt26

J Hepatol 2011.