Nonselective beta-blockers are effective in preventing variceal bleeding in patients with cirrhosis.
However, treatment with isosorbide-5-mononitrate (IS-MN), plus propranolol, achieves a greater reduction in portal pressure than propranolol alone.
In this study, researchers from Spain evaluated whether combined drug therapy was more effective than propranolol alone in preventing variceal bleeding.
The team assesses 349 consecutive cirrhotic patients with gastroesophageal varices.
| The only independent predictor of variceal bleeding was variceal size greater than 5 mm.|
Patients were randomized to receive either propranolol and placebo, or propranolol and IS-MN.
The researchers found no significant differences in the 1- and 2-year actuarial probability of variceal bleeding between the 2 groups.
They determined that the only independent predictor of variceal bleeding was variceal size greater than 5 mm.
In patients with varices over 5 mm, the team found no significant difference in the incidence of variceal bleeding between the 2 groups. Survival was also similar.
However, the researchers found that adverse effects occurred more frequently in the propranolol plus IS-MN group, as patients had a greater incidence of headache.
They did not identify any significant differences in the incidence of new-onset or worsening ascites, or in the impairment of renal function.
Dr Juan Carlos’s team concluded, “Propranolol effectively prevents variceal bleeding”.
“Adding IS-MN does not further decrease the low residual risk of bleeding in patients receiving propranolol”.
“However, the long-term use of this combination drug therapy is safe and may be an alternative in clinical conditions associated with a greater risk of bleeding”.