{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:17:28Z","timestamp":1784801848700,"version":"3.55.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2000,6,1]],"date-time":"2000-06-01T00:00:00Z","timestamp":959817600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2003,12,30]],"date-time":"2003-12-30T00:00:00Z","timestamp":1072742400000},"content-version":"vor","delay-in-days":1307,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2000,6]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>The aim of this study was to test the effectiveness of isosorbide-5-mononitrate (IM) as an adjunct to propranolol (PR) in the prevention of variceal rebleeding. Ninety-five cirrhotic patients with variceal bleeding were randomly assigned to treatment with PR + IM (46 patients) or PR alone (49 patients). Eighteen patients in the PR + IM group and 28 in the PR group had rebleeding during the 2 years after randomization. The actuarial probability of rebleeding 2 years after randomization was lower in the PR + IM group (40.4% vs. 57.4%) but the difference was not significant (<jats:italic toggle=\"yes\">P<\/jats:italic> = .09). However, the decrease in the risk of rebleeding reached statistical significance after stratification according to age, <jats:italic toggle=\"yes\">i.e.<\/jats:italic> less than 50 versus \u226550 years old, (<jats:italic toggle=\"yes\">P<\/jats:italic> = .03) or by adding an additional year of follow-up (<jats:italic toggle=\"yes\">P<\/jats:italic> = .05). No significant difference was found in rebleeding index and survival. The multivariate Cox analysis indicated first, that both treatment (<jats:italic toggle=\"yes\">P<\/jats:italic> = .03) and age (<jats:italic toggle=\"yes\">P<\/jats:italic> = .001) were factors predictive of rebleeding and second, that PR + MI reduced the risk of rebleeding by half (relative risk: 0.51, 95% confidence interval: 0.28-0.95). Seven patients in the PR + MI group and 1 patient in the PR group had to discontinue one of the drugs because of adverse events (<jats:italic toggle=\"yes\">P<\/jats:italic> = .03). These results suggest that the addition of IM improves the efficacy of PR alone in the prevention of variceal rebleeding in cirrhotic patients. However no beneficial effects were observed on other parameters reflecting the efficacy of treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1053\/jhep.2000.8106","type":"journal-article","created":{"date-parts":[[2004,3,19]],"date-time":"2004-03-19T18:37:43Z","timestamp":1079721463000},"page":"1239-1245","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":138,"title":["Isosorbide mononitrate and propranolol compared with propranolol alone for the prevention of variceal rebleeding"],"prefix":"10.1097","volume":"31","author":[{"given":"J\u00e9r\u00f4me","family":"Gournay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Masliah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Perrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Galmiche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"10.1053\/jhep.2000.8106-BIB1|cit1","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/0016-5085(81)90144-X","article-title":"The course of patients after variceal hemorrhage","volume":"80","author":"Graham","year":"1981","journal-title":"Gastroenterology"},{"key":"10.1053\/jhep.2000.8106-BIB2|cit2","doi-asserted-by":"crossref","first-page":"881","DOI":"10.3109\/00365528309182110","article-title":"Main causes of death in cirrhosis","volume":"18","author":"Schlichting","year":"1983","journal-title":"Scand J Gastroenterol"},{"key":"10.1053\/jhep.2000.8106-BIB3|cit3","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/BF01320309","article-title":"Survival and prognostic indicators in compensated and decompensated cirrhosis","volume":"31","author":"D'Amico","year":"1986","journal-title":"Dig Dis Sci"},{"key":"10.1053\/jhep.2000.8106-BIB4|cit4","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1002\/hep.1840040617","article-title":"Effects of propranolol on azygos blood flow and hepatic and systemic hemodynamics in cirrhosis","volume":"6","author":"Bosch","year":"1984","journal-title":"Hepatology"},{"key":"10.1053\/jhep.2000.8106-BIB5|cit5","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1002\/hep.1840110625","article-title":"Liver function and pharmacological considerations in pathogenesis and treatment of portal hypertension","volume":"11","author":"Reichen","year":"1990","journal-title":"Hepatology"},{"key":"10.1053\/jhep.2000.8106-BIB6|cit6","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1002\/hep.510250112","article-title":"Beta-adrenergic antagonists in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis","volume":"25","author":"Bernard","year":"1997","journal-title":"Hepatology"},{"key":"10.1053\/jhep.2000.8106-BIB7|cit7","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/hep.1840220145","article-title":"The treatment of portal hypertension: a meta-analytic review","volume":"22","author":"D'Amico","year":"1995","journal-title":"Hepatology"},{"key":"10.1053\/jhep.2000.8106-BIB8|cit8","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1016\/0016-5085(90)91168-6","article-title":"Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage","volume":"99","author":"Groszmann","year":"1990","journal-title":"Gastroenterology"},{"key":"10.1053\/jhep.2000.8106-BIB9|cit9","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/S0140-6736(95)91740-3","article-title":"Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis","volume":"346","author":"Feu","year":"1995","journal-title":"Lancet"},{"key":"10.1053\/jhep.2000.8106-BIB10|cit10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/hep.1840050120","article-title":"Increased portal venous resistance hinders portal pressure reduction during the administration of beta-adrenergic blocking agents in a portal hypertensive model","volume":"5","author":"Kroeger","year":"1985","journal-title":"Hepatology"},{"key":"10.1053\/jhep.2000.8106-BIB11|cit11","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/0016-5085(89)91630-2","article-title":"Reduction of portal pressure by isosorbide-5-mononitrate in patients with cirrhosis. 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