Effect of Carvedilol on Thrombocytopenia in Patients with Hepatitis C-Related Cirrhosis

Samiullah  Douna; Yasir Abbas  Zaidi; Qasim  Umar; Sohail  Safdar

doi:10.54112/bcsrj.v6i6.2075

Authors

Samiullah Douna Department of Gastroenterology, Nishtar Hospital, Multan, Pakistan
Yasir Abbas Zaidi Department of Gastroenterology, Nishtar Hospital, Multan, Pakistan
Qasim Umar Department of Gastroenterology, Nishtar Hospital, Multan, Pakistan
Sohail Safdar Nishtar Medical University, Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2075

Keywords:

Carvedilol, Cirrhosis, Hepatitis C, Platelet Count, Portal Hypertension, Thrombocytopenia

Abstract

Thrombocytopenia is a frequent complication in hepatitis C virus (HCV)–related cirrhosis, contributing to heightened bleeding risk and complicating management. Carvedilol, a non-selective β-blocker with additional α₁-adrenergic blocking properties, may alleviate portal hypertension and thereby improve platelet counts. Objective: To evaluate the effect of carvedilol on thrombocytopenia in patients with HCV-related cirrhosis. Methods: This prospective cohort study was conducted in the Department of Gastroenterology at Nishtar Hospital, Multan, Pakistan, from December 2024 to May 2025. Adults aged 20–60 years with PCR-confirmed HCV infection and clinically diagnosed cirrhosis were consecutively enrolled after informed consent. Standard exclusion criteria were applied. Carvedilol was titrated to achieve a 25% reduction from baseline heart rate. Platelet counts and vital signs were recorded at baseline and two weeks after completing the target heart rate, following standardised procedures. The primary outcome was a >15% increase in platelet count from baseline to two weeks (Yes/No). Secondary outcomes included absolute and relative changes in platelet count, and changes in heart rate and blood pressure. Data were analysed using paired t-tests and subgroup comparisons. Results: A total of 176 patients were enrolled (mean age 48.4 ± 9.1 years; 58.0% male). Carvedilol titration achieved the target physiological effects (mean heart rate reduction of −21 bpm; systolic BP reduction of −6 mmHg; diastolic BP reduction of −2 mmHg). Platelet counts increased from 98.2 ± 22.4 to 121.0 ± 26.3 ×10³/mm³ (mean change +22.8 ×10³/mm³; p<0.001). The primary endpoint was met in 68.8% (95% CI 62.0–75.6). No significant effect modification was observed across subgroups defined by age, sex, obesity, Child–Pugh class, variceal grade, diabetes, residence, or disease duration. Conclusion: In patients with HCV-related cirrhosis, carvedilol titrated to a 25% heart-rate reduction was associated with a clinically significant improvement in platelet counts within two weeks in approximately two-thirds of patients, without major hypotensive events. The effect was consistent across major clinical subgroups, supporting its potential role in the management of portal hypertension–associated thrombocytopenia.

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