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Preventing variceal bleeding. (Clinical Capsules).

Propranolol plus isosorbide-5-mononitrate is not more effective than propranolol alone in the primary prevention of variceal bleeding, reported Dr. Juan Carlos GarciaPagan of the University of Barcelona (Spain) and his associates.

Of 174 patients who were randomized to receive propranolol plus placebo in a double-blind trial, 15 had a first variceal bleed during an average follow-up of 16 months. In the propranolol plus isosorbide-5-mononitrate (IS-MN) group, 15 of 175 patients had a first variceal bleed (Hepatology 37[6]:1260-66, 2003).

The size of the varices and hematocrit level at the start of the study were the only variables in the univariate analysis that were associated significantly with variceal bleeding. When those two variables, the treatment received, and the Child-Pugh score were entered into the multivariate analysis, only a variceal size greater than 5 mm was associated independently with an increased risk of variceal bleeding. Significantly more of the propranolol plus ISMN patients (3 9%) had adverse effects than did propranolol plus placebo patients (26%), primarily due to headaches in the propranolol plus IS-MN group.
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Author:Evans, Jeff
Publication:Internal Medicine News
Article Type:Brief Article
Date:Jul 1, 2003
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