Propranolol in the Primary Prevention of Upper Gastrointestinal Tract Haemorrhage in Patients with Cirrhosis of the Liver and Oesophageal Varices1

Abstract

on behalf of a Multicentre Study Group2 2 For participants see p. 60. A prospective. randomised. multicentre. single-blind comparison of propranolol with placebo in the primary prevention of upper gastrointestinal haemorrhage was conducted in 230 cirrhotic patients with large oesophageal varices. The dose of propranolol was progressively increased until resting heart rate was reduced by 20 to 25%. The final doses were 40mg of conventional propranolol and 160 and 320mg of long-acting propranolol daily in 22. 60 and 18% of patients. respectively.Patients who survived without bleeding were folio wed up for 436 ± 172 days (mean ± SD). After 2 years. the cumulative percentages of patients free from bleeding were 74% in the propranolol group and 39% in the placebo group (p < 0.05). Similarly. cumulative 2-year survival was 72% in the propranolol group and 51% in the placebo group (p < 0.05).Propranolol was well tolerated and only 13 patients were withdrawn from treatment.We concluded that propranolol treatment decreased the incidence offirst bleeding and death during a period of 2 years in patients with cirrhosis and large oesophageal varices.

Ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhosis†

“…Because monotherapy13 and combination treatment with nitrates9 have have failed to prove superiority, PPL is still the adequate standard treatment for any trial on primary prophylaxis of variceal bleeding. The results obtained in our standard treatment arm (PPL) are well in line with the literature: the actuarial bleeding risk after 2 years is 17.6% in the present study and 22% in the large meta‐analysis of Poynard et al8 Recent trials by Lui et al (19%),13 Garcia‐Pagan et al (17% in patients with varices > 5 mm),9 and several others25–27 also reported similar bleeding rates. In the first trial comparing VBL and PPL for primary prophylaxis,18 the actuarial bleeding risk was very high in the PPL group (40% at 18 months); this prompted criticism concerning compliance and PPL dosage 28.…”

Adrenergic Agents in Correction of Portal Hypertension in Cirrhosis of the Liver

“…В то же время в другом ретроспективном исследовании с участием 95 человек установлено отсутствие дозозависимого влияния пропранолола в дозе 80-120 мг/сут на гемодинамический ответ у пациентов с ЦП и гастроэзофагеальным варикозом. Это свидетельствует о том, что низкие дозы пропранолола ниже целевой дозы могут привести к значительному гемодинамическому ответу и гораздо более безопасны и хорошо переносимы [17].…”