To print: Select File and then Print from your browser's menu

Title: Variceal Bleeding in Cirrhosis Poses Therapeutic Dilemma

URL: http://www.elsevier.com/gej-ng/10/26/38/93/50/32/abstract.html

Journal of Hepatology 2002;37(3):315-321 "Nadolol is superior to isosorbide mononitrate for the prevention of the first variceal bleeding in cirrhotic patients with ascites"
09/16/2002 01:07:27 PM
By David Loshak

While cirrhotic patients with ascites can tolerate isosorbide-mononitrate, it is ineffective. On the other hand, the beta-blocker nadolol is effective but not nearly as well tolerated. Noting that beta-blockers effectively prevent first variceal bleeding in cirrhotic patients but that patients with ascites could not use them because of their many contra-indications and side-effects, researchers in Milan and Magenta, Italy, compared the efficacy and applicability of nadolol and isosorbide-mononitrate in preventing first variceal bleeding in 80 consecutive cirrhotic patients. These patients had ascites and oesophageal varices with a high risk of bleeding - a 25 percent average risk at one year. Of the 80 patients, 28 were excluded because of contra-indications, leaving 52 to be randomly assigned to receive the beta-blocker (n=25) or the nitrate (n=27). The frequency of contra-indications with nadolol was 35 percent. There were no contra-indications with isosorbide-mononitrate. During follow-up of 21.3±11.6 months, side-effects forced six patients on nadolol and four on isosorbide-mononitrate to stop treatment. Bleeding occurred in two patients taking nadolol and in 10 taking isosorbide-mononitrate. The probability of bleeding was significantly lower in the nadolol group but overall survival was similar: seven patients on isosorbide-mononitrate and eight on nadolol died.

http://www.elsevier.com/gej-ng/10/26/38/93/50/32/abstract.html

Copyright © 2009 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content.