Korean J Med.  2014 Jan;86(1):42-48. 10.3904/kjm.2014.86.1.42.

Maximally Tolerable Versus Low Doses of Propranolol in the Prevention of Esophageal Variceal Rebleeding

• Kwon HY
• Ha KH
• Kim SY
• Park JH
• Kim JS
• Kim BS
• Lee CH

• KMID: 1867315
• DOI: http://doi.org/10.3904/kjm.2014.86.1.42

Abstract

BACKGROUND/AIMS
Beta-blockers have been used extensively to prevent esophageal variceal (EV) rebleeding in patients with liver cirrhosis. The aim of this study was to compare the rate of EV rebleeding according to the dose of beta-blocker, between maximally tolerable dose (MTD) and low dose (LD) groups.
METHODS
A total of 95 patients, who were treated with emergent EV ligation for acute EV bleeding and have since then taken propranolol for 1 month or longer, were enrolled. Forty-nine patients took propranolol at the MTD (154.7 +/- 10.1 mg/day), and 46 patients took propranolol at the LD (39.1 +/- 5.8 mg/day). The end point was occurrence of EV rebleeding.
RESULTS
The MTD and LD groups were well matched for age, sex, etiologies for cirrhosis, presence of ascites or encephalopathy, serum creatinine levels, and follow-up periods. The MTD group showed relatively lower Child-Pugh scores, mode for end stage liver disease (MELD) scores, and serum bilirubin, as well as shorter prothrombin time, but a higher dose reduction rate, as compared with the LD group. The rate of EV rebleeding was lower in the MTD group than the LD group (38.8% vs. 67.4%, p = 0.007). In the univariate analysis, the risk factors for EV rebleeding were Child-Pugh classification and dose of propranolol. However, the dose of propranolol was only a significant risk factor for EV rebleeding according to the multivariate analysis.
CONCLUSIONS
The effect of propranolol on the prevention of EV rebleeding was superior in the MTD group than in the LD group.

Keyword

Adrenergic Beta-Antagonists; Esophageal and Gastric Varices

MeSH Terms

Adrenergic beta-Antagonists
Ascites
Bilirubin
Classification
Creatinine
End Stage Liver Disease
Esophageal and Gastric Varices
Fibrosis
Follow-Up Studies
Hemorrhage
Humans
Ligation
Liver Cirrhosis
Multivariate Analysis
Propranolol*
Prothrombin Time
Risk Factors
Adrenergic beta-Antagonists
Bilirubin
Creatinine
Propranolol