Portal Vein Thrombosis Risk in Cirrhotic Patients With Portal Hypertension on Beta-Blockers: A Multi-Institutional Cohort Study
Recommended Citation
Abosheaishaa H, Elfert K, Abusuliman M, Ismail A, Olimy A, Alzamzamy AE, Omran A, Rizzo V, Nassar M, El-Kassas M. Portal Vein Thrombosis Risk in Cirrhotic Patients with Portal Hypertension on Beta-Blockers: A Multi-Institutional Cohort Study. Liver Int. 2026;46(9):e70843.
Document Type
Article
Publication Date
9-1-2026
Publication Title
Liver international : official journal of the International Association for the Study of the Liver
Keywords
Humans, Hypertension, Portal, Adrenergic beta-Antagonists, Liver Cirrhosis, Retrospective Studies, Propranolol, Carvedilol, Portal Vein, Venous Thrombosis, Female, Middle Aged, Male, Esophageal and Gastric Varices, Incidence, Ligation, Risk Factors, Kaplan-Meier Estimate, Aged
Abstract
BACKGROUND: Portal vein thrombosis (PVT) is a significant complication of cirrhosis. Nonselective beta-blockers (NSBBs) are standard therapy for portal hypertension, but their effect on PVT risk remains uncertain.
AIM: To assess whether NSBB use after variceal band ligation increases PVT risk and to compare outcomes among propranolol, carvedilol and no NSBB therapy.
METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network (> 110 million patients). Adults with cirrhosis and portal hypertension who underwent variceal band ligation (2010-2024) were included. Patients were stratified by NSBB exposure and matched 1:1 on 12 clinical variables. The primary outcome was incident PVT; secondary outcome was all-cause mortality. Kaplan-Meier analysis evaluated time-to-event outcomes.
RESULTS: After matching (n = 4296 per group), NSBB use was associated with higher PVT incidence compared with no NSBBs (9.5% vs. 5.4%; RR 1.765, 95% CI 1.500-2.077). Propranolol was associated with increased PVT risk, whereas carvedilol showed similar PVT incidence to controls and significantly lower mortality compared with both propranolol and no NSBB use.
CONCLUSIONS: Propranolol use was linked to increased PVT risk, while carvedilol did not elevate PVT risk and was associated with improved survival. Beta-blocker selection may meaningfully influence outcomes in cirrhosis.
Medical Subject Headings
Humans; Hypertension, Portal; Adrenergic beta-Antagonists; Liver Cirrhosis; Retrospective Studies; Propranolol; Carvedilol; Portal Vein; Venous Thrombosis; Female; Middle Aged; Male; Esophageal and Gastric Varices; Incidence; Ligation; Risk Factors; Kaplan-Meier Estimate; Aged
PubMed ID
42642993
Volume
46
Issue
9
First Page
70843
Last Page
70843
