Randomized, controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding
- 29 October 2012
- journal article
- research article
- Published by Wiley in Journal of Gastroenterology and Hepatology
- Vol. 27 (11), 1681-1687
- https://doi.org/10.1111/j.1440-1746.2012.07244.x
Abstract
Carvedilol has been shown to be more effective than propranolol in decreasing portal pressure. Sufficient data from controlled trials remains limited. This trial compared the relative safety and efficacy between carvedilol and nadolol plus isosorbide mononitrate in preventing variceal rebleeding. After successful control of acute esophageal variceal bleeding, eligible patients were randomized to the carvedilol group, 61 patients, using carvedilol 6.25-12.5 mg daily or the N + I group, 60 patients, using nadolol 40-80 mg plus isorsorbide-5-mononitrate 20 mg daily. The end points were rebleeding from varices, adverse events or death. After a median follow up of 30 months, recurrent upper gastrointestinal bleeding developed in 37 patients (61%) in the carvedilol group and 37 patients (62%) in the N + I group (P = 0.90). Recurrent bleeding from esophageal varices occurred in 31 patients (51%) in the carvedilol group and in 26 patients (43%) in the N + I group (P = 0.46). Recurrent bleeding from gastric varices occurred in two patients (3%) in the carvedilol group and in eight patients (13%) in the N + I group (P = 0.05). Severe adverse events occurred in one patient in the carvedilol group and 17 patients in the N + I group (P < 0.0001). Fifteen patients of the carvedilol group and 17 patients in the N + I group died (P = 0.83). Two patients in the carvedilol group and three patients in the N + I group died of variceal bleeding. Carvedilol was as effective as nadolol plus isorsorbide-5 -mononitrate mononitrate in the prevention of gastroesophageal variceal rebleeding with fewer severe adverse events and similar survival.Keywords
This publication has 30 references indexed in Scilit:
- Carvedilol for portal hypertension in patients with cirrhosisJournal of Hepatology, 2010
- Management of Varices and Variceal Hemorrhage in CirrhosisThe New England Journal of Medicine, 2010
- A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleedingJournal of Gastroenterology and Hepatology, 2009
- Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleedJournal of Hepatology, 2009
- Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleedingJournal of Hepatology, 2008
- Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosisJournal of Hepatology, 2002
- Carvedilol, a new nonselective beta-blocker with intrinsic anti-alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosisJournal of Hepatology, 1999
- Propranolol for Prevention of Recurrent Gastrointestinal Bleeding in Patients with CirrhosisThe New England Journal of Medicine, 1981
- Prediction of variceal hemorrhage by esophageal endoscopyGastrointestinal Endoscopy, 1981
- Transection of the oesophagus for bleeding oesophageal varicesBritish Journal of Surgery, 1973