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Long-term follow-up of hemodynamic responders to pharmacological therapy after variceal bleeding.
MedLine Citation:
PMID:  22378235     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Although it is assumed that hemodynamic responders to pharmacological therapy after a variceal hemorrhage are adequately protected from rebleeding, there is no evidence that either this response or its protective effect extend beyond the usual 2-year follow-up featured in available studies. We aimed to assess the maintenance of hemodynamic response and its impact on outcomes in a large cohort of hemodynamic responders during a long follow-up. One hundred and three cirrhotic patients admitted with acute variceal bleeding between 2001-2010 were prospectively evaluated. The hepatic venous pressure gradient (HVPG) was determined 5 days after the bleeding and repeated 5-7 days after maximal tolerated doses of nadolol and nitrates. Hemodynamic responders (HVPG ≤12 mmHg or ò20% decrease from baseline) were maintained on drugs and followed-up with annual HVPG measurements. Forty-eight patients (47%) were hemodynamic responders. Median follow-up was 48 months (range 2-108). Long-term HVPG evaluations could not be performed in 8 patients (4 deaths, 2 rebleedings, 2 follow-up <1 year). Among the remaining 40 patients, hemodynamic response was maintained in 26 (65%) and lost in 14 (35%). There were no baseline differences between both subgroups. However, 100% of alcoholic patients who remained abstinent maintained long-term response, compared to 36% of non-abstinent alcoholics (p<0.001) and 50% of patients with viral cirrhosis (p=0.002). Patients with loss of hemodynamic response rebled more during follow-up (79% vs. 11%, p<0.001) and showed a higher incidence of death or liver transplant (50% vs. 15%, p=0.029). CONCLUSIONS: After variceal bleeding, long-term maintenance of hemodynamic response to drug therapy is mainly restricted to patients with alcoholic cirrhosis who remain abstinent. The loss of this long-term response carries worse clinical outcomes. (HEPATOLOGY 2012.).
Authors:
Salvador Augustin; Antonio González; Laia Badia; Laura Millán; Aranzazu Gelabert; Alejandro Romero; Antoni Segarra; María Martell; Rafael Esteban; Jaime Guardia; Joan Genescà
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-1
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  -     ISSN:  1527-3350     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Association for the Study of Liver Diseases.
Affiliation:
Liver Unit, Department of Internal Medicine; Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain.
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