Lack of clinical or haemodynamic rebound after abrupt interruption of beta-blockers in patients with cirrhosis

Summary

Background

Beta-blockers may have to be interrupted in patients with cirrhosis. The concept of a rebound after interruption of beta-blockers is based on an animal study and on isolated case reports of variceal bleeding.

Aim

To determine if a rebound occurs in patients with cirrhosis following abrupt interruption of beta-blockers.

Methods

We prospectively included all consecutive patients with cirrhosis undergoing right heart and hepatic vein catheterisation. Four groups were defined: 'no beta-blockers' including patients not receiving beta-blockers; '≤1 day', '2–3 days' and '≥4 days' classified according to the time patients had interrupted beta-blockers before catheterisation. Results were expressed as median (interquartile range).

Results

A total of 150 patients were included. Among the 25 patients in the groups '2–3 days' and '≥4 days', median duration of beta-blockers interruption was 4 (3–6) days. No gastrointestinal bleeding occurred during that period, nor during the following month. Hepatic venous pressure gradient was not different among patients in usually treated with beta-blockers. After adjustment, beta-blockers interruption was not associated with hepatic venous pressure gradient. Cardiac index was higher in the '≥4 days' group [4.6 L/min/m² (3.5–5.1)] than in the '≤1 day' group [3.4 (2.6–4.0); P = 0.001] or in the '2–3 days' group [3.1 (2.7–3.7); P = 0.007], but not different from the 'no beta-blockers' group.

Conclusions

Abrupt interruption of beta-blockers is associated neither with an apparent increase in the risk of variceal bleeding nor with a haemodynamic rebound. Thus, interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance.

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