VARICEAL HEMORRHAGE—TO BLOCK OR NOT TO BLOCK?

Eighty-one cirrhotics, bleeding from esophageal varices, were randomized to receive either propranolol (38) or placebo (43) for 2 yr in an attempt to prevent rebleeding. The initial bleeding episode was controlled with conventional medical therapy, including up to one sclerotherapy treatment. A single dose of propranolol was selected, Inderal L.A. [R] 160 mg daily. Bleeding and death were the major end-points. Severe variceal hemorrhage occurred in 77% of those given placebo but only 47% of those receiving propranolol. Death rates were similar (44% and 37%, respectively). Side effects were uncommon and equal in both groups. The difference in rebleeding rates approached statistical significance (p = 0.07); the death rates did not. The tendency for propranolol to benefit was seen in all Child's classes.