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Variceal Bleeding in Cirrhosis Poses Therapeutic Dilemma
A DGReview of :"Nadolol is superior to isosorbide mononitrate for the prevention of the first variceal bleeding in cirrhotic patients with ascites"
Journal of Hepatology
09/16/2002
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.
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"
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