EFFECTS OF ISOSORBIDE-5-MONONITRATE COMPARED WITH PROPRANOLOL ON FIRST BLEEDING AND LONG-TERM SURVIVAL IN CIRRHOSIS

Background & Aims: Isosorbide-5-mononitrate (Is-5-Mn) exerts beneficia l hemodynamic effects in portal hypertension, yet the long-term clinic al value is uncertain. The aim of this study was to determine the long term effects of Is-5-Mn vs. propranolol (Pro) on first bleeding, compl ications, and death in cirrhosis. Methods: One hundred eighteen patien ts included in a previously published randomized trial comparing Is-5- Mn (20 mg three times daily) with Pro were followed up for up to 7 yea rs (range, 2-91 months). Fifty-seven patients received Is-5-Mn and 61 received Pro. Results: Thirty episodes of first upper bleeding occurre d; 16 were in the Is-5-Mn group. Actuarial probability of bleeding did not differ between the two groups. Endoscopic variceal red signs were the only independent predictors of early bleeding. Of the 52 patients who died, 28 were in the Is-5-Mn group. The likelihood of death was g reater among patients assigned to Is-5-Mn than to Pro, but only in pat ients older than 50 years (72% vs. 48% at 6 years; P = 0.006). Child-P ugh score, bleeding, age, and assignment to Is-5-Mn were independent p redictors of death. The likelihood of death without bleeding was also higher (P = 0.05) in the Is-5-Mn group. Conclusions: Is-Ei-Mn is as ef fective as Pro in preventing early bleeding but,is associated with hig her long-term mortality.