Treatment with isosorbide 5-mononitrate in the prevention of acute rebleeding episodes in patients with cirrhosis

Călin Mitre¹, Daniela Frenţ², Horaţiu Branda³, Marcel Tanţău⁴

1. Catedra de Anestezie Terapie intensivă UMF „Iuliu Haţieganu” Cluj-Napoca
2. Clinica ATI Spitalul Clinic de Adulţi Cluj-Napoca
3. Catedra de Imagistică Medicală, UMF „Iuliu Haţieganu” Cluj-Napoca
4. Catedra de Gastroenterologie Med.III, UMF „Iuliu Haţieganu” Cluj-Napoca

Abstract

Background
The purpose of this randomized double blind and prospective study was to evaluate the efficiency of treatment with mononitrate for reduction of portal hypertension and the incidence of complications (acute rebleeding from esophageal varices and number of deaths) in the cirrhotic patient admitted to the Intensive Care Unit.

Methods
We compared the effects of 40mg isosorbide 5-mononitrate (MonoMack) and placebo administered for five days in 22 patients with hepatic cirrhosis admitted to the ICU with a hemorragic episode from esophageal varices. The haemodynamic data (MAP and pulse) and the portal velocity (EchoDoppler) as well as rebleeding were evaluated.
Results were analyzed using chi-square, Student’s t-test with statistical significance p<0.05 and confidence interval (CI) 95%. Data were expressed as mean ± SD.

Results
Isosorbide 5-mononitrate slightly decreased the mean arterial pressure (MAP) and increased the pulse frequency (p>0.05) but significantly reduced the portal velocity compared to the initial value (p<0.05). The incidence of complications was not significantly reduced. In contrast placebo administration had no significant effects.

Conclusions
The results of this study show that isosorbide 5-mononitrate: 1. reduced portal pressure with minimal systemic alterations; 2. could be effective in the reduction of the acute rebleeding episodes from esophageal varices in patients with cirrhosis.
Key words: cirrhosis, isosorbide-5-mononitrate, rebleeding, esophageal varices

Jurnalul Român de Anestezie Terapie intensivă 2003 Vol.10 Nr.1, 35-39

Tratamentul cu mononitraţi în prevenirea episoadelor hemoragice acute la pacientul cu ciroză hepatică