Portal Vein Thrombosis Risk in Cirrhotic Patients With Portal Hypertension on Beta‐Blockers: A Multi‐Institutional Cohort Study
Year: 2026
Type: article
Study design: Observational Study
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.
Source: Liver International
DOI: 10.1111/liv.70843
Institutions: Mount Sinai Queens, Icahn School of Medicine at Mount Sinai, West Virginia University, Henry Ford Health, Henry Ford Hospital, Cleveland Clinic Florida, Menoufia University, Military Medical Academy, Trinitas Regional Medical Center, University at Buffalo, State University of New York, Helwan University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7204261087