P2820 - Secondary and Tertiary Prophylaxis of Esophageal Variceal Bleeding: Can We Be Doing Better?

Mahmoud Aryan, MD, Nida Choudry, MD, Yassmin Hegazy, MD, Sujan Ravi, MD, Nishah Panchani, MD, Mohamed Shoreibah, MD
University of Alabama at Birmingham, Birmingham, AL

Introduction: Non-selective beta blockers (NSBBs) are recommended by the American Association for the Study of Liver Disease (AASLD) for primary and secondary prophylaxis of variceal hemorrhage (VH). Patients with an episode of VH have high risk of rebleeding and mortality. Following variceal ligation, the AASLD recommends instituting NSBB therapy at discharge to reduce portal pressure and rebleeding risk. We investigated the utilization of NSBBs for prevention of VB.

Methods: We performed a retrospective review of cirrhotic patients admitted for VH at a tertiary center from 2017-2020. Patient demographics, co-morbidities, vital signs on discharge, and cirrhosis etiology were recorded. Data on initiation of NSBBs at discharge was also obtained. Study cohorts were stratified based on use of NSBB prior to admission and history of VH. Categorical and continuous variables were presented as a frequency percentage and mean ± standard deviations respectively.

Results: A total of 91 patients (67% male, mean BMI 30, 21% NASH and 23% related to alcohol use) were included in the study among which 48 (53%) were not on NSBB at admission. Fifty-seven (63%) patients had permissible vital signs for NSBB initiation; however, only 46 (80%) of these patients were initiated on NSBBs at discharge. After group stratification, 60 patients were admitted with their first VH, of which 22 (37%) were on NSBBs prior to admission. Of the 38 patients not on NSBB prior to admission, 23 patients had blood pressures permissible for NSBB use at discharge but only 14 (61%) of these patients were discharged on NSBBs. Of the 31 patients with recurrent VH, only 21 (68%) were on NSBB prior to admission. For the remaining 10 patients not on NSBBs, 5 were eligible for NSBBs at discharge, but only 3 (60%) of these patients were appropriately discharged on NSBBs. For those taking NSBBs prior to admission, 100% of patients eligible for NSBB therapy at discharge were indeed discharged on a NSBB regardless of history of VH.

Discussion: About 40% of the patients admitted for VH with permissible vital signs for NSBB use at discharge were not prescribed NSBBs. This was similar in those that presented either with their first or recurrent VH. However, NSBB use was continued among all patients who were already on NSBB at the time of admission. Further studies to investigate the implementation of quality assurance measures to improve the utilization of NSBBs for reducing the risk of recurrent VH are needed.



Disclosures:


Mahmoud Aryan, MD, Nida Choudry, MD, Yassmin Hegazy, MD, Sujan Ravi, MD, Nishah Panchani, MD, Mohamed Shoreibah, MD. P2820 - Secondary and Tertiary Prophylaxis of Esophageal Variceal Bleeding: Can We Be Doing Better?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.