| Hemodynamic effects of propranolol and nitrates in cirrhotics with transjugular intrahepatic portosystemic stent-shunt. | |
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MedLine Citation:
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PMID: 12374234 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The combination of tailored TIPS with vasoactive drugs might allow reduction of the rate of subsequent shunt-related sequelae. METHODS: We studied cirrhotic patients 8 weeks (median) after TIPS insertion (8-10 mm) for variceal bleeding. Nitrate (0.1 mg/kg) and propranolol (0.15 mg/kg) alone or combined (same dosages) were infused (I h) sequentially at 1-h intervals (n = 17). Similarly, propranolol was randomly compared to placebo (NaCl, n = 14). We measured mean arterial pressure (MAP, mmHg), heart rate (HR) and portal pressure gradient (PPG: portal minus central venous pressure) prior to and after drugs. RESULTS: Propranolol reduced PPG (mean +/- s, mmHg) significantly (14.8 +/- 3.7 versus 12.1 +/- 3.7; -21% +/- 10%; P < 0.001), while nitrates alone (14.3 +/- 3.4 versus 13.7 +/- 3.4; -11% +/- 3%; P=0.06) or nitrates plus propranolol (12.9 +/- 4 versus 12.4 +/- 4; -7% +/- 8%; P=0.2) induced only minor additive effects on portal pressure. However, nitrate reduced MAP (P < 0.001) and increased HR (P < 0.01), whereas propranolol reduced only HR (P < 0.001) with unchanged MAP, and the combination decreased MAP (P < 0.001). Compared to placebo (no effect), propranolol decreased PPG (14.4 +/- 5.6 versus 11.1 +/- 5.5; -23% +/- 11%; P < 0.001) and HR (P < 0.001). Overall, most patients (92%) responded to propranolol and 54% showed a marked PPG decrease (>20%). CONCLUSIONS: Propranolol significantly reduced portal pressure in cirrhotic patients after TIPS, whereas nitrates induced only minor benefit. TIPS-treated patients might therefore profit from additive propranolol therapy allowing limited shunts to be applied initially and/or to reduce the need for TIPS revisions in the case of shunt-dysfunction during follow-up. |
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Authors:
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K A Brensing; M Hörsch; J Textor; P Schiedermaier; P Raab; M Schepke; H Strunk; H Schild; T Sauerbruch |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Scandinavian journal of gastroenterology Volume: 37 ISSN: 0036-5521 ISO Abbreviation: Scand. J. Gastroenterol. Publication Date: 2002 Sep |
Date Detail:
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Created Date: 2002-10-10 Completed Date: 2003-02-03 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0060105 Medline TA: Scand J Gastroenterol Country: Norway |
Other Details:
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Languages: eng Pagination: 1070-6 Citation Subset: IM |
Affiliation:
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Dept of Internal Medicine, University of Bonn, Germany. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Blood Pressure
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drug effects Drug Combinations Female Heart Rate / drug effects Hemodynamics / drug effects* Humans Hypertension, Portal / prevention & control Liver Cirrhosis / physiopathology* Male Middle Aged Nitroglycerin / therapeutic use* Portal Pressure / drug effects Portasystemic Shunt, Transjugular Intrahepatic* Propranolol / therapeutic use* Treatment Outcome Vasodilator Agents / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Drug Combinations; 0/Vasodilator Agents; 525-66-6/Propranolol; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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