Study of Propranolol in Cirrhosis Patients with Portal Hypertension: Research at Sidoarjo General Hospital

Abstract

Cirrhosis is the final stage of chronic liver disease caused by fibrosis which decreases the function and changes the shape and structure of the liver. Portal hypertension is an essential pathophysiology of cirrhosis, which can lead to an increased risk of death in patients resulting in very detrimental complications originating from portal obstruction of blood flow, such as cirrhosis or blockage of blood vessels. According to the EASL guidelines, non-selective β-blocker therapy such as propranolol can reduce portal pressure by reducing the portal venous flow through two mechanisms: decreased cardiac output and decreased splanchnic blood flow. This study aimed to determine the pattern of using propranolol in patients with liver cirrhosis in Sidoarjo Hospital. This was an observational study with a retrospective approach in cirrhosis patients with portal hypertension from 1st January 2021 until 31st December 2021. The Patient Medication Records (PMR) data was obtained from 15 male patients (68%), with the most age ranging from 56 to 65 years old (37%). The pattern of using single therapy was in 22 patients (100%). The highest use of single treatment was Propranolol (3×10 mg) with 12 patients (52%), Propranolol (2x10 mg) with ten patients (43%), and Propranolol (2x40 mg) with only one patient (5%). Interm of switching therapy, only one medication which is Propranolol (2x10 mg switch toPropranolol (2x40 mg).


Keywords: Propranolol, Portal Hypertention, Cirrhosis

References
[1] Joseph TD, Yee GC, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. The Australian Journal of Hospital Pharmacy. 2020;27(3):340–340.

[2] Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world [Internet]. J Hepatol. 2019 Jan;70(1):151–71.

[3] Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis [Internet]. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2650– 66.

[4] Suva M. REVIEW ARTICLE A Brief Review on Liver Cirrhosis : Epidemiology, Etiology, Pathophysiology, Symptoms, Diagnosis and Its Management. 2018;( July).

[5] Nelci AG. Asuhan Keperawatan Pada TN. K. P. dengan Gangguan Sirosis Hepatis Di Ruangan Komodo RSUD Prof. Dr. W.Z Johanes Kupang [Internet]. Journal of Chemical Information and Modeling. 2020;43:7728 .

[6] Yao H, Zhang C. Angiotensin II receptor blockers for the treatment of portal hypertension in patients with liver cirrhosis: a systematic review and meta-analysis of randomized controlled trials. Ir J Med Sci. 2018 Nov;187(4):925–34.

[7] Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. 2020;9327

[8] Yusminingrum WT, Widajati E, Kholidah D. Gambaran Asuhan Gizi Pada Pasien Sirosis Hepatis Dengan Hematemesis Melena Di Rumah Sakit Umum Daerah Dr Saiful Anwar Malang. J Inf Kesehat Indones [Internet]. 2019;5(2):79–101.

[9] Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al.; European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406–60.

[10] Nur AC. Studi Penggunaan Propranolol Pada Pasien Sirosis Hepatis Dengan Hipertensi Portal (Penelitian di Rumah Sakit Umum Daerah Sidoarjo). Angew Chemie Int. 2019;6(11), 951–952.

[11] Yulianda D, Maharani L, Suryoputri MW. Penggunaan Albumin Oral dan Albumin Injeksi pada Pasien Sirosis Hati di RSUD Prof. Dr. Margono Soekarjo Purwokerto. Acta Pharm Indones Acta Pharm Indo. 2020;8(1):8.

[12] Sulistyoningrum E, Murtisiwi L. Description Of Preparation In Installation of Panti diagnosis di Instalasi Rawat Jalan Rumah Sakit. J Pharm (Cairo). 2019;9(1):1–7.

[13] Vaz J, Eriksson B, Strömberg U, Buchebner D, Midlöv P. Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study. BMC Gastroenterol. 2020 Apr;20(1):84.

[14] Bouayad A, Laamiri FZ, Elmoumou L, Rezzouk B, Hadef R. Prevalence of liver fibrosis and cirrhosis in 699 Moroccan patients with chronic hepatitis C. Pan Afr Med J. 2021 May;39:32.

[15] Wiranata IM, Hasmono D, Surdijati S, Farmasi F, Airlangga U. Studi Penggunaan Omeprazole pada Pasien Sirosis Hati dengan Hemetamesis Melena Rawat Inap di RSUD Kabupaten Sidoarjo Fakultas Farmasi. Universitas Katolik Widya Mandala Surabaya, Indonesia The Study of Omeprazole in Cirrhosis Patients with Hematemesis M. 2017;4(1):25–9.

[16] Berzigotti A, Bosch J. Pharmacologic management of portal hypertension. Clin Liver Dis. 2014 May;18(2):303–17.

[17] Al-Majed AA, Bakheit AH, Abdel Aziz HA, Alajmi FM, AlRabiah H. Propranolol. Profiles Drug Subst Excip Relat Methodol. 2017;42:287–338.

[18] Yasuko I. Pathophysiology of Portal Hypertension. 2015;18(2):281–91.

[19] Perdani RRW. Hipertensi Portal pada Anak Portal Hyprtension in Children General factor. 2017;1:603–11.