Propranolol in the prevention of recurrent variceal hemorrhage in cirrhotic patients

Garden, O. James; Mills, Peter R.; Birnie, G G; Murray, Gordon D.; Carter, D.C.

doi:10.1016/0016-5085(90)91308-s

Cited by 98 publications

(19 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Comment: Several RCTs proved that nonselective bblockers are effective in preventing initial [110] or recurrent [111] hemorrhage from esophageal varices. Several RCTs have reported that b-blockers were as effective as EVL in preventing initial variceal bleeding [112,113] or as effective as EIS in preventing recurrent variceal bleeding [114], whereas other RCTs have reported that EVL was more effective than propranolol for the primary prevention of high-risk variceal bleeding [115,116].…”

Section: Antifibrotic Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

View full text Add to dashboard Cite

The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

show abstract

Section: Antifibrotic Therapymentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

View full text Add to dashboard Cite

show abstract

“…On the contrary, the effectiveness of sclerotherapy among patients already treated with propranolol has rarely been shown (13) but deserves further attention, especially in severely cirrhotic patients. Decision making is rather difficult for these patients, because the risks of both recurrent bleeding and death are high (14)(15)(16), P-blockade is not very effective (17)(18)(19) and complications of sclerotherapy occur frequently and are sometimes life-threatening (20). Therefore the aim of the present study was to compare the effectiveness of considered eligible for inclusion if they met the following criteria: (a) a recent episode of bleeding from esophageal varices that was confirmed by emergency endoscopy (endoscopic stigmata of recent variceal bleeding or esophageal varices with no other pathological condition present to explain major upper gastrointestinal trace bleeding); (b) bleeding that had stopped for at least 24 hr without any sclerotherapy session; (c) a Child-Pugh score greater than 6 (21); and (d) oral acceptance to participate from the patient or from the next of kin if the patient was too ill to consent.…”

Section: ;16912-919)mentioning

confidence: 99%

Does Elective Sclerotherapy Improve the Efficacy of Long–Term Propranolol for Prevention of Recurrent Bleeding in Patients With Severe Cirrhosis? A Prospective Multicenter, Randomized Trial

et al. 1992

View full text Add to dashboard Cite

We conducted a prospective, multicenter, randomized trial to compare the efficacy of sclerotherapy plus propranolol with that of propranolol alone in the prevention of recurrent gastroesophageal bleeding in severely cirrhotic patients. For 2 yr (1987 to 1988) 131 patients (96% of whom were alcoholic) with Child-Pugh class B or C cirrhosis (56% were class B and 44% were class C) were randomly assigned to one of our two treatment groups after cessation of variceal bleeding, without hemostatic sclerosis, and were observed for at least 2 yr. Treatment observance was good in 89% of cases; alcohol withdrawal was observed in 62% of cases. Sclerotherapy was performed weekly with 1% polidocanol, and variceal obliteration was obtained in 83% of cases, in a mean number of four sessions. The cumulative percentages (expressed as mean +/- S.D.) of recurrent bleeding at 2 yr were 42% +/- 6% for propranolol plus sclerotherapy and 59% +/- 6% for propranolol alone (a nonsignificant difference). Twenty-eight patients from the propranolol group but only 12 patients from the propranolol-plus-sclerotherapy group had recurrent bleeding from esophageal variceal rupture (p less than 0.01). The total number of blood units per patient with recurrent bleeding was slightly but not significantly more important in the propranolol group (8 +/- 7) than in the propranolol-plus-sclerotherapy group (5 +/- 5; p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

show abstract

“…3. 4) Since our previous meta-analysis [6] in cluding eight RCTs [20][21][22][23][24][25][26][27] only one further RCT has been published [28]. Two other RCTs.…”

Section: Rct O F Fi-blockers For Llte Prevention O Fmentioning

confidence: 99%

“…-In five of seven RCTs showing a reblceding rate reduction larger than 0.10 no Child C patients were included. In one of the re maining two [28], patients who rebled within 15 days were excluded, suggesting a selection of patients in fairly good condi tion (16% Child C): In the last of these seven RCTs [27]. a large proportion of decompensated patients was found in the first 3 months after the index bleeding, when the bleeding risk was at its peak.…”

Section: Rct O F Fi-blockers For Llte Prevention O Fmentioning

confidence: 99%

Prevention of Upper Gastrointestinal Bleeding from Portal Hypertension in Cirrhosis: Rationale for Medical Treatment

Pagliaro

D’Amico

Tinè

et al. 1992

Dig Dis

View full text Add to dashboard Cite

We updated meta-analysis and critical descriptive analysis of randomized clinical trials (RCTs) assessing the value of β-blockers in preventing first bleeding (prophylactic) or rebleed-ing (therapeutic) and on survival of patients with cirrhosis. Both the methods of Peto-Mantel-Haenszel and DerSimonian-Laird were used to assess the heterogeneity and obtain cumulative estimates of treatment effects; the L’Abbé plot was also used for a visual assessment of heterogeneity in the direction of treatment effect. Seven prophylactic and nine therapeutic RCTs were analysed. β-Blockers uniformly reduced the bleeding risk and revealed a trend toward improved survival in non-ascitic, well-compensated patients in both the prophylactic and therapeutic sets of RCTs. Discordant results were found in patients with ascites or in poor functional condition.

show abstract

Propranolol in the prevention of recurrent variceal hemorrhage in cirrhotic patients

Cited by 98 publications

References 31 publications

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Does Elective Sclerotherapy Improve the Efficacy of Long–Term Propranolol for Prevention of Recurrent Bleeding in Patients With Severe Cirrhosis? A Prospective Multicenter, Randomized Trial

Prevention of Upper Gastrointestinal Bleeding from Portal Hypertension in Cirrhosis: Rationale for Medical Treatment

Contact Info

Product

Resources

About