Propranolol Better Than Ligation for Variceal Bleeding

A new study has found that propranolol--a non-selective beta-adrenergic receptor blocking agent--is a more effective prophylaxis treatment for variceal bleeding than ligation in patients awaiting liver transplantation.

Researchers from the University of Padova (Italy) compared the safety and benefits of endoscopic variceal ligation versus propranolol in the prevention of first variceal bleeding in 62 patients with Child-Turcotte-Pugh B-C cirrhosis and high-risk varices. The patients received propranolol (31 patients) or variceal banding (31 patients); the primary endpoint was variceal bleeding. The study was terminated after the interim analysis, when it became clear that a much larger sample size would be required to demonstrate significant differences between the treatments.

Study results showed there were no significant differences in the rates of first esophageal variceal hemorrhage, overall mortality, or bleeding-related mortality between the groups. Two patients in the endoscopic variceal ligation group and five in the propranolol group had adverse events requiring interruption of treatment, but only variceal ligation was associated with fatal complications. The study was published in the September 2007 issue of Liver Transplantation.

"Both propranolol and endoscopic banding are similarly effective in reducing the incidence of variceal bleeding in cirrhotic patients with high-risk varices, candidates for liver transplantation,” said Dr. Lorenzo Norberto and colleagues of the department of surgical and gastroenterological sciences, "but ligation can be complicated by severe and fatal bleeding and is significantly more expensive. Our results suggest that banding should not be utilized as the primary prophylaxis in candidates for liver transplantation who can be treated with beta-blockers.”

Propranolol was the first successful beta blocker developed and is mainly used in the treatment of hypertension, angina pectoris, and arrhythmia.


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