Propranolol in primary and secondary prophylaxis of variceal bleeding among cirrhotics in India: a hemodynamic evaluation.
OBJECTIVE
In the present study, we attempted to complete the hemodynamic assessment of propranolol response in cirrhotics with esophageal varices at high risk of bleeding, in one sitting, so as to identify nonresponders at the earliest. Some noninvasive indicators of this response were also evaluated.


METHODS
Hepatic venous pressure gradient (HVPG) was measured in 33 such cases (18 nonbleeders, 15 bleeders) before and 90 min after an oral dose of 80 mg propranolol, and reduction by > or =20% taken as responder.


RESULTS
Twenty-two patients (66.67%) responded (HVPG reduction > or =26%), whereas 11 (33.33%) did not (HVPG reduction < or =6%). Postdrug HVPG between responders and nonresponders showed a significant difference (p < 0.001). Neither baseline HVPG (p > 0.1), baseline CI (p = 0.665), nor baseline stroke volume index (p > 0.1) could predict responder status. Difference of HVPG reduction (percent) between bleeders (21.49 +/- 35.53) and nonbleeders (40.58 +/- 23.95) approached, but did not reach, statistical significance (p = 0.076). However, logistic regression showed this difference to be significant (p = 0.026). Age of responders was found to be significantly lower than that of nonresponders (p approximately equals 0.05). During a follow-up of 9-38 months, only one of 22 responders (on propranolol) had an episode of variceal bleed. None in whom HVPG fell to < or = 12 mm Hg bled.


CONCLUSIONS
The study suggests that single-sitting hemodynamic assessment of acute response to high-dose oral propranolol clearly differentiates between responders and nonresponders. Moreover, it appears that prior history of variceal bleeding and old age negatively influences the effect of propranolol.
De
B K
BK
Department of Medicine, Institute of Post Graduate Medical Education and Research, Calcutta, India.
Sen
S
S
Biswas
P K
PK
Sengupta
D
D
Biswas
J
J
Santra
A
A
Hazra
B
B
Maity
A K
AK
D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000517:prevention & control*; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D007194:India; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011315:Preventive Medicine / Q000379:methods*; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D014690:Venous Pressure / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D011433:Propranolol