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Isosorbide-5-mononitrate versus propranolol in the prevention of first bleeding in cirrhosis.

AbstractBACKGROUND:
Hemodynamic studies have shown the efficacy of nitrates in reducing portal pressure in cirrhosis. We therefore studied the efficacy of isosorbide-5-mononitrate vs. propranolol in the prevention of first bleeding within a prospective controlled trial.
METHODS:
One hundred eighteen cirrhotics with esophageal varices were blindly randomized to receive 20 mg of isosorbide-5-mononitrate three times a day (n = 57) or propranolol (n = 61) up to the maximum tolerated dose. Both groups also received ranitidine (150 mg/day).
RESULTS:
The median follow-up was 29 months. Twenty-six patients dropped out (13 in the isosorbide group) because of poor compliance or complications unrelated to treatment. Eighteen patients died (9 in the isosorbide-treated group), 6 due to bleeding. The 1- and 2-year actuarial percentages of patients free of bleeding was 90.8% and 82.2% in the isosorbide-5-mononitrate--and 93.9% and 85.8% in the propranolol-treated groups, respectively (P = NS). These values are higher than those expected from the North Italian Endoscopic Club predicting scores. There were few major side effects in either group. The 2-year survival rate did not differ between the two groups (82.2% vs. 85.4%).
CONCLUSIONS:
Isosorbide-5-mononitrate administered orally is a safe and effective alternative to propranolol in the prophylaxis of bleeding in cirrhosis.
AuthorsM Angelico, L Carli, C Piat, S Gentile, V Rinaldi, E Bologna, L Capocaccia
JournalGastroenterology (Gastroenterology) Vol. 104 Issue 5 Pg. 1460-5 (May 1993) ISSN: 0016-5085 [Print] United States
PMID8482456 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Propranolol
  • Isosorbide Dinitrate
  • isosorbide-5-mononitrate
Topics
  • Aged
  • Digestive System (pathology)
  • Endoscopy
  • Female
  • Gastrointestinal Hemorrhage (etiology, prevention & control)
  • Humans
  • Isosorbide Dinitrate (adverse effects, analogs & derivatives, therapeutic use)
  • Liver Cirrhosis (complications, drug therapy, mortality)
  • Male
  • Middle Aged
  • Patient Dropouts
  • Personnel Selection
  • Propranolol (adverse effects, therapeutic use)
  • Prospective Studies

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