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Randomized, controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding.
J Gastroenterol Hepatol 2012; 27(11):1681-7JG

Abstract

BACKGROUND AND AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Department of Medical Research, Digestive Center, E-DA Hospital, Kaohsiung, Taiwan. ghlo@kimo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22849337

Citation

Lo, Gin-Ho, et al. "Randomized, Controlled Trial of Carvedilol Versus Nadolol Plus Isosorbide Mononitrate for the Prevention of Variceal Rebleeding." Journal of Gastroenterology and Hepatology, vol. 27, no. 11, 2012, pp. 1681-7.
Lo GH, Chen WC, Wang HM, et al. Randomized, controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. J Gastroenterol Hepatol. 2012;27(11):1681-7.
Lo, G. H., Chen, W. C., Wang, H. M., & Yu, H. C. (2012). Randomized, controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. Journal of Gastroenterology and Hepatology, 27(11), pp. 1681-7. doi:10.1111/j.1440-1746.2012.07244.x.
Lo GH, et al. Randomized, Controlled Trial of Carvedilol Versus Nadolol Plus Isosorbide Mononitrate for the Prevention of Variceal Rebleeding. J Gastroenterol Hepatol. 2012;27(11):1681-7. PubMed PMID: 22849337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized, controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. AU - Lo,Gin-Ho, AU - Chen,Wen-Chi, AU - Wang,Huay-Min, AU - Yu,Hsien-Chung, PY - 2012/8/2/entrez PY - 2012/8/2/pubmed PY - 2013/5/10/medline SP - 1681 EP - 7 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 27 IS - 11 N2 - BACKGROUND AND AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/22849337/Randomized_controlled_trial_of_carvedilol_versus_nadolol_plus_isosorbide_mononitrate_for_the_prevention_of_variceal_rebleeding_ L2 - https://doi.org/10.1111/j.1440-1746.2012.07244.x DB - PRIME DP - Unbound Medicine ER -