Patients with liver cirrhosis and refractory ascites have low MAP and renal vasoconstriction that can lead to circulatory dysfunction, therefore they can be vulnerable to the use of NSBB.
NSBB are effective treatment for prophylaxis of variceal bleeding. Many patients patients receive this treatment. Do you think that these drugs must be avoided in all patients with refractory ascites?
Hi
I don't think so because its beneficial effects but the 25% decrease in heart rate as evidence of adequate beta-adrenergic blockade with NSBBs. It is usually advised that NSBBs be titrated until the maximum tolerated dose, provided the systolic blood pressure remains above 90 mmHg and heart rate above 55 bpm. Till the clinician achieved a stable maintenance dose.
I agree with your recommendation Huda Ibrahim.
Do you use propranolol or carvedilol? And how?
Thank you very much for your attention
It has been identified that the mechanisms by which non-selective beta-blockers could impair survival in patients with refractory ascites. different researches showed that peripheral vasodilation and sympathetic activation lead to increased left ventricle systolic function in patients with cirrhosis and ascites, which acts as an adaptive mechanism to maintain renal perfusion. In patients with cirrhosis and refractory ascites, the use of NSBBs may increase mortality. However, the NSBB users may have had a poorer condition at baseline compared to the nonusers.
A recent study has suggested that nonselective β-blockers promote more harm than benefit in patients who have cirrhosis and refractory ascites.