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World J Gastroenterol. Mar 28, 2008; 14(12): 1908-1913
Published online Mar 28, 2008. doi: 10.3748/wjg.14.1908
Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial
Binay K De, Deep Dutta, Rimi Som, Pranab K Biswas, Subrata K Pal, Anirban Biswas
Binay K De, Deep Dutta, Rimi Som, Pranab K Biswas, Subrata K Pal, Anirban Biswas, Department of Medicine, Medical College Calcutta 88, College Street Calcutta 700073 and Institute of Cardiovascular Sciences, RG Kar Medical College, Calcutta 32, Gorachand Road, Kolkata 700014, India
Author contributions: De BK conceptualized the study; De BK and Dutta D designed the research; Dutta D and Som R performed the research; Biswas PK performed hemodynamic assessments; Som R, Biswas PK and Pal SK analyzed the data; Dutta D, Pal SK, and Biswas A wrote the paper and contributed equally to this work.
Correspondence to: Binay K De, Department of Medicine, Medical College, 64/4A/1A Dr. Suresh Chandra Banerjee Road, Calcutta 700010, India. binaykde@hotmail.com
Telephone: +91-33-23731060
Received: October 10, 2007
Revised: January 3, 2007
Published online: March 28, 2008

AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding.

METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day.

RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05).

CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.

Keywords: Hepatic venous pressure gradient, Secondary prophylaxis, Spironolactone, Propranolol, Variceal bleeding