Oral isosorbide mononitrate was then started at 20 mg once at bedtime, followed by 20 mg twice a day for 1 day, and finally increased to 40 mg BD if tolerated. Once the maximal tolerated drug doses were achieved, a second hemodynamic study was scheduled 5-7 days later. According to the hemodynamic response observed, patients were classified in two groups: responders, when the HVPG was ≤12 mm Hg and/or had decreased ≥20% from baseline values; and nonresponders, when these hemodynamic click here targets were not achieved. According

to available recommendations, responders were maintained with the same pharmacological therapy (drugs only) until their first rebleeding episode or the end of follow-up (regardless of the results of follow-up HVPG measurements). Only if a first rebleeding episode occurred was ligation prophylaxis added to drug therapy in responders. Nonresponders were treated from the start with the combination of drugs and endoscopic ligation, except for a few buy LBH589 patients at the beginning of the study period who received a transjugular portosystemic shunt (TIPS). Ligation was performed with commercial multiband devices at 2- to 3-week intervals until variceal obliteration had been achieved. Once eradicated, patients underwent a follow-up endoscopy

at 3 months and at 6-month intervals thereafter. Additional sessions of ligation were conducted if varices reappeared. None of the patients with hepatitis C in this cohort of decompensated patients with cirrhosis received antiviral therapy during follow-up, in line with available recommendations. Patients were followed at 3-month intervals at the outpatient liver clinic. History and examination evaluated alcohol abstinence, compliance to drug therapy and adverse effects. Alcohol abstinence was assessed by direct anamnesis with the patient, separated interview with close relatives and unexpected determinations of alcoholemia. Compliance to drug therapy was assessed in all patients by blood pressure and heart rate measurements at each follow-up visit, in addition to a specific anamnesis. Moreover, responders underwent

annual determinations of HVPG for selleck chemicals llc 3 years. The study was continued for 6 months after the enrollment of the last patient. Diagnosis of cirrhosis was based on liver biopsy or the usual clinical and imaging criteria. Bleeding was considered from esophageal variceal origin when the emergency endoscopy performed within 12 hours after admission showed any of the accepted criteria defining variceal bleeding.14 The primary endpoints of the study were maintenance of long-term response, rebleeding and the composite of death and liver transplantation (LT). These endpoints were prespecified before the beginning of the study. An initial hemodynamic responder was considered to maintain long-term response if all follow-up HVPG measurements were ≤12 mm Hg and/or >20% of baseline value.