Entry characteristics and outcome data were collected from the physicians of patients participating in 4 randomized trials on propranolol and nadolol 1. Patients were followed for 2 years in 2 studies and for 1 year in the others. Patients had a spectrum of severity of cirrhosis (2 trials excluded severe cases) and esophageal varices but no previous variceal bleeding. Patients had been randomized to propranolol (n = 203) or nadolol (n = 83) in doses that reduced the heart rate by approximately 25%, or to placebo (n = 165), ranitidine (n = 49), or vitamin K (n = 89).
Fatal and nonfatal upper gastrointestinal bleeding and total mortality were reported over a mean follow-up period of 491 days.
27% (82) of comparison patients, but only 16% (49) of beta blocker patients had gastrointestinal bleeding (relative risk reduction, 41%; number needed to treat to prevent 1 bleeding episode = 10). The case-fatality rates within 6 weeks of bleeding were 52% and 43% among comparison and beta blocker patients, respectively (95% CI for difference of 10%, -8% to 27%). Total mortality at 2 years was 32% among comparison patients and 29% among b-blocker patients (P >0.2). (This summary was abstracted from an ACP Journal Club abstract).
Comment: The quality of evidence is downgraded by sparse data.
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