Propranolol in primary and secondary prophylaxis of variceal bleeding among cirrhotics in India: a hemodynamic...

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Pharmacology

Background:

• Esophageal varices in cirrhotic patients pose a significant bleeding risk.
• Propranolol is used to manage this risk, but predicting response can be challenging.
• Early identification of nonresponders is crucial for timely alternative treatment.

Purpose of the Study:

• To assess the hemodynamic response to propranolol in cirrhotic patients with esophageal varices at high risk of bleeding.
• To identify nonresponders early through a single-sitting assessment.
• To evaluate noninvasive indicators of propranolol response.

Main Methods:

• Hepatic venous pressure gradient (HVPG) was measured before and 90 minutes after a single oral dose of 80 mg propranolol in 33 patients.
• A reduction in HVPG by ≥20% was defined as a positive response.
• Baseline hemodynamic parameters and patient history were analyzed for predictive value.

Main Results:

• 66.67% of patients responded to propranolol, with a significant difference in post-drug HVPG between responders and nonresponders (p < 0.001).
• Neither baseline HVPG, cardiac index, nor stroke volume index predicted responder status.
• A history of variceal bleeding and older age were associated with a poorer response to propranolol (logistic regression, p = 0.026 for bleeding history; p ≈ 0.05 for age).

Conclusions:

• Single-sitting hemodynamic assessment of acute propranolol response effectively differentiates responders from nonresponders in cirrhotic patients with esophageal varices.
• Prior variceal bleeding history and older age appear to negatively influence propranolol's effectiveness.
• This approach facilitates early identification of nonresponders, allowing for prompt therapeutic adjustments.