Studies have suggested that the prognosis of patients with cirrhosis and variceal hemorrhage has improved more recently.
Physicians from France performed a prospective cohort study where the choice of prophylactic therapy was left to each practitioner. The team followed cirrhotic patients with medium and large varices in order to determine which factors predict bleeding and death.
There were 314 patients with grades 2 or 3 esophageal varices enrolled in the study. Of these, 173 had no previous history of variceal bleeding.
Not all patients were receiving some form of prophylactic therapy. While 100% of patients with prior variceal hemorrhage were receiving prophylactic therapy, only 61% of patients without prior hemorrhage were.
Overall, the median follow-up was 18 months.
|9 deaths occurred within 24 hours of bleeding onset.|
|Journal of Hepatology|
The physicians found that there were 76 bleeding events and 14 related deaths. They determined that 9 of the deaths occurred within 24 hours of bleeding onset.
In addition, there were 25 deaths that were not due to bleeding, but were related to cirrhosis.
Using a Cox model, the physicians identified that the presence of tense ascites (relative risk 3.4), and a history of hemorrhage (relative risk 4.4) were independent predictors of variceal hemorrhage.
They also found that in patients with no history of bleeding, bleeding risk was higher with prolonged prothrombin time, and lower when patients were receiving propranolol.
Dr Delphine Nidegger's team concluded, "Despite the advent of effective drugs and endoscopic therapy for variceal bleeding, about a quarter of deaths occur very early after bleeding onset, confirming the need for rapid specific management".