Monotherapy vs. Combination Therapy for Preventing First Variceal Hemorrhage

Current guidelines recommend either a β-blocker or endoscopic band ligation (EBL) for prevention of a first variceal hemorrhage (VH) in patients with cirrhosis. To prevent variceal rebleeding, a combination of β-blocker therapy and EBL has been shown to be superior to a β-blocker alone. Now, researchers have compared combination therapy with a β-blocker alone for prevention of a first variceal hemorrhage.

At a digestive center in Taiwan, 140 patients with cirrhosis and no history of VH were enrolled; all had varices of at least moderate size and with high-risk signs (red wale markings or cherry-red spots). Participants were randomized to receive either nadolol alone (initially, 40 mg/day; then adjusted to reduce the resting heart rate by 25%…