Nadolol is superior to isosorbide mononitrate for the prevention of the first variceal bleeding in cirrhotic patients with ascites

Gianmario Borroni, Francesco Salerno, Massimo Cazzaniga, Franco Bissoli, Elettra Lorenzano, Alessandra Maggi, Stefania Visentin, Anna Panzeri, Roberto De Franchis

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Aims: β-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 β-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 β-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.

Original languageEnglish
Pages (from-to)315-321
Number of pages7
JournalJournal of Hepatology
Volume37
Issue number3
DOIs
Publication statusPublished - Sep 2002

Keywords

  • β-Blockers
  • Ascites
  • Bleeding
  • Cirrhosis
  • Isosorbide-5-mononitrate
  • Nadolol
  • Nitrates
  • Prophylaxis
  • Varices

ASJC Scopus subject areas

  • Gastroenterology

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