Cirrhosis Clinical Trial
Official title:
Secondary Prophylaxis After Variceal Bleeding: Combined Treatment With Endoscopic Ligation and Nadolol Against Nadolol Associated With Mononitrate of Isosorbide or Prazosin According to Hemodynamic Response.
Controlled and randomized study comparing combined treatment (nadolol and endoscopic ligation) versus nadolol associated with isosorbide mononitrate or prazosin according to hemodynamic response, in the prevention of esofagic verices rebleeding.
The present is a prospective, randomized, open label study, in parallel groups, in which the
patients with hemorrhage caused by esofagic varices will be randomized in two groups of
treatment, after control of acute hemorrhage.
All the patients included will receive standard medical treatment with beta - blockers and
endoscopic ligation of the esofagic varices.
The control group will be constituted by the patients assigned to receive endoscopic
ligation and nadolol (N).
The experimental group will be constituted by patients assigned to receive treatment
according to the hemodynamic response.
All patients included in the experimental group will receive pharmacologic treatment with
nadolol combined with Isosorbide Mononitrate (MNI) or Prazosin (PZ).
In both groups it will practice a basal hepatic hemodynamic study in the 4th-5th day after
their admitance (after achieve hemodynamic stability for at least 48 h and with hemorrhage
controlled) and a second control hepatic hemodynamic study 3-4 weeks after the beginning of
the pharmacologic treatment, once adjusted doses.
In the experimental group, the responders to N + MNI will keep on this treatment, but
nonrespondent in the hemodynamic study will switch treatment to N + PZ and a third hepatic
hemodynamic study will be performed 3 to 4 weeks after the dosage adjustement.
The randomization will be stratified according to the degree of hepatic failure measured by
Child-Pugh classification (classes A and B versus C) The design is random to avoid bias in
the selection of the patients.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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