Nitrates (either alone or in combination with -blockers), shunt therapy, or sclerotherapy should
used in the primary prophylaxis of variceal
hemorrhage (Class III, Level A).
this is saying is that all patients with varices should be taking a beta-blocker to prevent the first bleed. It reduces the portal hypertension that we with scared livers have. Why is this important and basic treatment for all cirrhotics? Because once we bleed the chances of future bleeds goes way up.