EFFECT OF PROPRANOLOL ON PREVENTION OF 1ST VARICEAL BLEED AND SURVIVAL IN PATIENTS WITH CHRONIC LIVER-DISEASE

Background: Propranolol has been shown to be effective in both primary and secondary treatment of variceal haemorrhage; most primary prevent ion trials have only included patients with large oesophageal varices. Aim of the study: The aim of this study was to look at the effect of propranolol in the primary prevention of variceal bleeding and its lon g-term effects on mortality in unselected patients with chronic liver disease. Methodology: Three hundred and nineteen patients were include d in a double-blind parallel group study in three centres to receive p ropranolol 160 mg long-acting (LA) or placebo. Patients were followed up for a minimum of one year. Results: There were eleven episodes of v ariceal bleeding and 38 deaths with no statistically significant diffe rence in bleeding rates between the two treatment groups. Child's grou p and history of ascites were the most important prognostic factors de termining the likelihood of early death and variceal bleeding respecti vely. Conclusions: In this study we failed to demonstrate a significan t effect of propranolol on first variceal bleeding or in prolonging su rvival in unselected patients with chronic liver disease. Our results, however, might have been influenced by the low event rate observed in these unselected group of patients and suggest that careful selection of patients who are most likely to benefit from propranolol is import ant.