EFFECTS OF PROPRANOLOL COMPARED WITH CLONIDINE ON PORTAL HEMODYNAMICS- A DOUBLE-BLIND CROSS-OVER STUDY USING DUPLEX-DOPPLER ULTRASONOGRAPHY

Background: Patients with liver cirrhosis and large oesophageal varice s run a high risk of digestive haemorrhage due to the rupture of oesop hageal varices, an event associated with a high mortality. At present, the only treatment for the prevention of first bleeding from oesophag eal varices on which there is general agreement is drug-based. In orde r to tailor drug treatment to the requirements of individual patients more precisely, an ever-increasing number of drugs is being investigat ed. Design: Double-blind cross-over study. Methods: Sixteen cirrhotic patients with large oesophageal varices were studied by means of duple x-Doppler ultrasonography to determine variations in portal haemodynam ics after oral administration of 0.150 mg clonidine and to compare the se with the variations observed after oral administration of 40 mg pro pranolol. Results: Propranolol caused a significant reduction in maxim um portal flow velocity (P<0.001), whereas clonidine failed to cause a ny such variation (P=0.194). Considering as responders those patients who exhibited at least a 10% decrease in maximum portal flow velocity, 11 patients responded to propranolol; of these, three also responded to clonidine. No patient responded only to clonidine. Conclusion: The absence of any effects on the parameters of portal haemodynamics would appear to deny clonidine any significant role in preventing first ble eding resulting from the rupture of oesophageal varices.