Nadolol is superior to isosorbide mononitrate for the prevention of the first variceal bleeding in cirrhotic patients with ascites.
OBJECTIVE
beta-blockers effectively prevent first variceal bleeding (FVB) in cirrhotic patients. In patients with ascites, however, their use might be precluded by a high rate of contraindications and side effects. We compared the efficacy and applicability of nadolol and isosorbide-mononitrate (IsMn) in preventing FVB in a population of cirrhotic patients at high risk of variceal bleeding with ascites, who can be frequently intolerant to beta-blockers.


METHODS
A total of 80 consecutive cirrhotic patients with ascites and esophageal varices (25% average risk of bleeding at 1 year) were considered, 28 were excluded due to contraindications and 52 were randomly assigned to receive nadolol (n=25) or IsMn (n=27).


RESULTS
Frequency of contraindications was greater for beta-blockers than IsMn (35 versus 0%, P=0.001). During 21.3+/-11.6 months of follow-up, side effects forced six patients taking nadolol and four taking IsMn to stop treatment. Bleeding occurred in two patients taking nadolol and ten taking IsMn. The probability of bleeding was significantly lower in the nadolol group (P<0.05), whereas overall survival was similar (seven patients on IsMn and eight on nadolol died, P=0.3).


CONCLUSIONS
In patients with ascites IsMn is tolerated but ineffective while nadolol is effective but less tolerated.
Borroni
Gianmario
G
Medicina Generale, Ospedale G. Fornaroli, Magenta, Italy.
Salerno
Francesco
F
Cazzaniga
Massimo
M
Bissoli
Franco
F
Lorenzano
Elettra
E
Maggi
Alessandra
A
Visentin
Stefania
S
Panzeri
Anna
A
de Franchis
Roberto
R
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications / Q000401:mortality; D001794:Blood Pressure; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006339:Heart Rate; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D007668:Kidney / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009248:Nadolol / Q000008:administration & dosage*; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D009248:Nadolol; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate