Transdermal nitroglycerin in cirrhosis. A 24-hour echo-Doppler study of splanchnic hemodynamics.
OBJECTIVE
The present study was aimed to evaluate the 24-hour effect of transdermal nitroglycerin on splanchnic hemodynamics in cirrhotic patients.


METHODS
Hemodynamic parameters (blood velocity and resistance indexes) were determined by means of pulsed echo-Doppler, a non-invasive method which proved to be useful to evaluate the effects of drugs on splanchnic vessels. Nine patients with biopsy-proven liver cirrhosis were studied. They were kept on a standard diet divided into 3 meals served at 8, 12 a.m. and 6 p.m. Echo-Doppler measurements were determined for 2 consecutive days at 7, 8, 9, 12 a.m, 1, 3, 6, 7, 9, 12 p.m. and again at 7 a.m. A transdermal nitroglycerin tape, capable of releasing 15 mg of the drug in 24 h, was applied to the skin of the chest at 7 a.m. of the second day.


RESULTS
After nitroglycerin mean portal blood velocity and flow significantly decreased by 18 and 22%. Similarly superior mesenteric artery velocity decreased, while resistance indexes increased. ANOVA analysis showed a significant effect of the drug on superior mesenteric artery and portal flow, while the effect on hepatic artery flow and renal indexes were low.


CONCLUSIONS
This study shows that nitroglycerin, given as transdermal long-acting system, significantly influences portal hemodynamics in liver cirrhosis. Its use, favoured by easy administration, may be proposed for long-term clinical studies to test its efficacy in preventing gastrointestinal bleeding.
Instituto di Clinica Medica Generale e Terapía Medica, University of Bologna, Italy.
M
M
Zoli
D
D
Magalotti
G
G
Ghigi
G
G
Marchesini
E
E
Pisi
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity / Q000187:drug effects; D002940:Circadian Rhythm; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D013152:Splanchnic Circulation / Q000187:drug effects / Q000502:physiology*; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods*; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D005996:Nitroglycerin