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document
Cirrhosis and bleeding : the need for very early management . BACKGROUND/AIMS Retrospective studies suggest that the prognosis of patients with cirrhosis and variceal hemorrhage has improved in more recent decades . In a prospective cohort study in which the choice of prophylactic therapy was left to each practitioner , we followed cirrhotic patients with medium/large varices to determine factors predictive of bleeding and death . METHODS Three hundred fourteen patients with grades 2 or 3 esophageal varices ( Child A and B/C : 218 and 96 ) were enrolled . One hundred seventy-three patients had no previous history of variceal bleeding . Only 245 patients ( 100 % of patients with prior variceal hemorrhage , 61 % of patients without prior hemorrhage ) were receiving some form of prophylactic therapy . The median follow-up was 18 months . RESULTS There were 76 bleeding events and 14 related deaths ( 18 % ) ; nine of these deaths occurred within 24 h of bleeding onset ( two at home , two during hospital transfer , and five in hospital , a mean of 2.5 h after onset ; six involved Child C patients ) . Twenty-five deaths were not due to bleeding but were closely related to cirrhosis . In a Cox model , the presence of tense ascites ( relative risk 3.4 , 95 % confidence interval , CI 2.5-5.9 ) and a prior history of hemorrhage ( relative risk 4.4 , 95 % CI 2.6-7.5 ) were independent predictors of variceal hemorrhage . In patients without a prior history of bleeding , bleeding risk was higher with more prolonged prothrombin time and lower when patients were receiving propranolol . CONCLUSIONS Despite the advent of effective drugs and endoscopic therapy for variceal bleeding , about a quarter of deaths occur very early after bleeding onset , confirming the need for rapid specific management .
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Intervention_Pharmacological
prophylactic therapy
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Intervention_Pharmacological
prophylactic therapy
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Intervention_Pharmacological
propranolol
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Intervention_Physical
endoscopic therapy
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Outcome_Physical
bleeding events
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Outcome_Mortality
related deaths
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Outcome_Physical
bleeding
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Outcome_Mortality
deaths
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Outcome_Physical
variceal hemorrhage
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Outcome_Physical
bleeding , bleeding risk
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Outcome_Mortality
deaths
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Participant_Condition
cirrhosis and variceal hemorrhage
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Participant_Condition
cirrhotic
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Participant_Sample-size
Three hundred fourteen
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Participant_Sample-size
245