Acute and chronic hemodynamic changes after propranolol in patients with cirrhosis under primary and secondary prophylaxis of variceal bleeding: a pilot study.
OBJECTIVE
Prophylactic treatment of variceal bleeding in cirrhotic patients with beta-blockers is effective in only some patients. Our aim was to determine whether the response of the hepatic venous pressure gradient (HVPG) to the intravenous administration of propranolol predicts the response after chronic oral propranolol treatment.


METHODS
We included prospectively cirrhotic patients with esophageal varices under primary prophylaxis (PP) and secondary prophylaxis (SP). The HVPG was measured at baseline and after a propranolol bolus (0.15 mg/kg intravenous). A patient was considered a good-responder if HVPG decreased to 12 mmHg or 20% from baseline. Patients then received oral propranolol (heart rate titrated). Poor-responders under SP were also included in a variceal band ligation program. After at least 3 months, a second hemodynamic study was conducted.


RESULTS
Fifty-six patients were included (36 SP and 20 PP). Response rate was similar (32.1 and 41.9%, P=0.7) and the Pearson's correlation coefficient was 0.61 (P=0.001). In 81.4% patients, the first study predicted the response status of the second. Six patients rebled on follow-up between the studies, all of them were poor responders to intravenous propranolol.


CONCLUSIONS
A single hemodynamic study using intravenous propranolol seems to predict chronic response to propranolol.
Unidad hepática, Hospital General Universitario de Alicante, Alicante, Spain.
Enrique
E
de-Madaria
José María
JM
Palazón
Flavia Tamara
FT
Hernández
José
J
Sánchez-Paya
Pedro
P
Zapater
Javier
J
Irurzun
Francisco
F
de España
Sonia
S
Pascual
José
J
Such
Laura
L
Sempere
Fernando
F
Carnicer
Antonio
A
García-Herola
Jaime
J
Valverde
Miguel
M
Pérez-Mateo
D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011433:Propranolol / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome; D014690:Venous Pressure / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D011433:Propranolol