Beta-blockers alone or in combination with isosorbide mononitrate for secondary prevention of bleeding from gastro-esophageal varices in adults with cirrhosis and gastro-oesophageal varices

Background: cirrhosis of liver is a diffuse process of fibrosis that converts the liver architecture into structurally abnormal nodules Portal hypertension leads to dilatation of portal vein, splenomegaly, and formation of portal systemic collaterals at different sites. Screening endoscopy is recommended for early detection of esophageal varices (EVs) in cirrhotic patients with portal hypertension. However, this approach is limited by its invasiveness and cost. The aim of the study was to determine if platelet count can predict the presence of EVs, especially large (grade III, IV) EVs in need of prophylactic therapy.Methods: Statistically 100 patients previously or newly diagnosed with cirrhosis of liver with portal hypertension without history of hepatic encephalopathy, variceal bleeding, EVL, use of beta blockers, were selected for the study. Ultrasonography was performed in all cases to note the spleen size. Routine blood testing including platelet count was done and UGI-Endoscopy was done to detect presence of varices with grades. Statistical Analysis: Statistical analysis was done using Statistical Package for Social Survey (SPSS) for Windows version 17.0. The data obtained was analysed using mean, SD, Student’s t-test and chi square correlation coefficient, p value <0.05 was considered significant.Results: Among 100 patients studied ,90% patients were found to have esophageal varices. Based on endoscopic grading, incidence of grade 2 and grade 3 esophageal varices predominated, accounting to 48% and 23 % respectively. On correlation of platelet count with grades of esophageal varices it was evident that 44 patients had their platelet count less than 1 lac out of which 24 patients had grade 2 varices followed by 14 patients with grade 3 varices, p value <0.001 and was highly significant.Conclusions: The study depicts that with decrease in platelets count the chances of formation of higher grades of oesophageal varices increases and also a positive association exists.

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Mortality and Reinfarction among Patients Using Different Beta-Blockers for Secondary Prevention after a Myocardial Infarction

Cardiology ◽

10.1159/000143389 ◽

2009 ◽

Vol 112 (2) ◽

pp. 144-150 ◽

Cited By ~ 9

Author(s):

Søren Skøtt Andersen ◽

Morten Lock Hansen ◽

Gunnar H. Gislason ◽

Fredrik Folke ◽

Tina Ken Schramm ◽

...

Keyword(s):

Myocardial Infarction ◽

Secondary Prevention ◽

Beta Blockers

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Portal fibrosis and schistosomal portal hypertension: what is the best strategy for primary and secondary prevention of hemorrhage from esophageal varices

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032003000100001 ◽

2003 ◽

Vol 40 (1) ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Paulo L. Bittencourt

Keyword(s):

Portal Hypertension ◽

Secondary Prevention ◽

Esophageal Varices ◽

Primary And Secondary Prevention ◽

Portal Fibrosis

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Immature Platelet Fraction as a Non-Invasive Marker for Esophageal Varices

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i330821 ◽

2021 ◽

pp. 55-64

Author(s):

Alyaa Marzouk Soliman ◽

Sherief Mohamed Abd-Elsalam ◽

Amal Saeid ALBendary ◽

Osama El. Sayed Negm

Keyword(s):

Esophageal Varices ◽

Significant Positive Correlation ◽

Oesophageal Varices ◽

P Value ◽

Positive Correlation ◽

Non Invasive ◽

Immature Platelet Fraction ◽

Significant Difference ◽

Cirrhotic Patients ◽

Group 1

Background: All cirrhotic patients should be screened for oesophageal varices (OV) at the time of diagnosis. The development of a non-invasive method for the detection of OV is a vital issue in subjects with cirrhosis to decrease the need for invasive endoscopic procedures that can be costly. This work aimed to evaluate immature platelet fraction (IPF) as a non-invasive marker and predictor of OV. Methods: This cross-sectional study was carried out on 80 cirrhotic patients with esophageal varices diagnosed by upper endoscopy. They were divided into Group (1): 40 patients with cirrhosis with esophageal varices and Group (2): 40 patients with cirrhosis and without esophageal varices. All patients were subjected to the complete history taking, physical examination, routine laboratory investigations (Complete blood count, IPF, C-reactive protein, Liver and kidney function tests, Bone marrow aspiration for some cases, Ascetic sample analysis when applicable), Pelvic-Abdominal ultrasonography, Child Pugh score assessment, Upper GIT endoscopy. Results: There was a significant difference between the studied groups regarding IPF (p<0.001). At cutoff >12 IPF had (AUC= 0.993) with sensitivity of 97.5% and specificity of 97.5% for detection of esophageal varices. There was a significant negative correlation between IPF and platelets count (p- value < 0.001). There was a significant positive correlation between IPF and Child Pugh score (p- value <0.001). There was a highly significant positive correlation between IPF and CRP (p value <0.001). There was significant difference between the two groups as regards splenic longitudinal diameter (p<0.001). As regards platelet count, there was a significant difference between the two groups (p<0.001). It was significantly lower in Group 1. Conclusions: IPF is elevated in cirrhotic patients with naive esophageal varices than in cirrhotic patients without varices. IPF could be used as a noninvasive, easy to measure method for detection of the presence of esophageal varices at a cutoff level of >12.

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Beta-blockers versus placebo or no intervention for primary prophylaxis of oesophageal varices in children

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd011973 ◽

2015 ◽

Cited By ~ 7

Author(s):

Juan Cristóbal Gana ◽

Lorena I Cifuentes ◽

Jaime Cerda ◽

Luis A Villarroel del Pino ◽

Alfredo Peña ◽

...

Keyword(s):

Beta Blockers ◽

Primary Prophylaxis ◽

Oesophageal Varices

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Abstract P331: Secondary Prevention After Acute Coronary Syndrome with Microsize Myocardial Infarctions in the Reasons for Geographic and Racial Differences in Stroke-Myocardial Infarction (REGARDS-MI) Study

Circulation ◽

10.1161/circ.125.suppl_10.ap331 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Niket Nathani ◽

Monika M Safford ◽

Christopher Gamboa ◽

Mallika Mundkur ◽

Shannon Preston ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Secondary Prevention ◽

Racial Differences ◽

Cardiac Troponin ◽

Beta Blockers ◽

Community Dwelling ◽

Prevention Measures ◽

Coronary Syndrome ◽

Similar Range

Background: Studies have shown increased mortality after myocardial infarction (MI) with low level elevations of cardiac troponin (“microsize MI”) and subsequent risk reduction with intensive medical management. However, non-standard reporting and highly sensitive assays of cardiac troponin can make the clinical recognition of microsize MI difficult, creating barriers to the implementation of appropriate secondary prevention. Methods: REGARDS follows 30,239 community-dwelling participants of the 48 continental states age ≥45 years recruited from 2003-7; 41% of the sample was African American and 55% female by design. Following national consensus guidelines, experts adjudicated cases of acute coronary syndrome (ACS), defined as an admission for acute signs or symptoms of ischemia, and MI from hospital records. We studied first cases of ACS, classified as: 1) ACS without MI, 2) ACS+microsize MI (peak troponin <0.5), and 3) ACS+usual MI (peak troponin ≥0.5), to compare whether secondary prevention medications were prescribed at hospital discharge among these 3 groups. We used multivariable logistic regression to examine odds ratios for receipt of medications at discharge associated with microsize MI and no MI relative to usual MI. Results: The 1,238 cases of ACS were mean age 68.0+/-8.7 years, 59% male, and 66% white. Of these, 917 had discharge medications available. Compared to those with ACS+usual MI, individuals with ACS+microsize MI had lower odds of receiving beta-blockers and statins at discharge in a similar range as those without MI ( Table ). Conclusion: Individuals hospitalized for ACS and microsize MI were less likely to receive guideline appropriate secondary prevention measures than those with usual MI.

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