Budd-Chiari syndrome medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | ==Medical Therapy== | ||
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===Medical Therapy=== | ===Medical Therapy=== | ||
*Medical therapy can be used for short-term symptomatic relief.However, the use of such medical therapy alone is associated with a high 2-year mortality rate. | *Medical therapy can be used for short-term symptomatic relief.However, the use of such medical therapy alone is associated with a high 2-year mortality rate. | ||
* | *A low-sodium diet is recommended for patients of Budd-Chiari syndrome. This helps in effective control of ascites. | ||
*Symptomatic treatment includes [[diuretics]] to control ascites, anticoagulants such as [[heparin]] and [[warfarin]] for hypercoagulable state. | |||
===Anticoagulation=== | ===Anticoagulation=== | ||
*Anticoagulation is recommended in all patients of BCS to prevent progression of the thrombosis. | *Anticoagulation is recommended in all patients of BCS to prevent progression of the thrombosis. | ||
Revision as of 19:59, 9 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
Medical Therapy
- The therapy for Budd-Chiari syndrome is aimed at alleviating the obstruction.Underlying conditions are aggressively treated.
- Patients with Budd-Chiari syndrome are treated according to the severity of the disease.Treatment options include:
- Initial Medical therapy
- Endovascular procedure to restore vessel patency include
- Angioplasty
- Stenting
- local thrombolysis
- Transjugular portosystemic shunt (TIPS)
- Liver transplantation
Medical Therapy
- Medical therapy can be used for short-term symptomatic relief.However, the use of such medical therapy alone is associated with a high 2-year mortality rate.
- A low-sodium diet is recommended for patients of Budd-Chiari syndrome. This helps in effective control of ascites.
- Symptomatic treatment includes diuretics to control ascites, anticoagulants such as heparin and warfarin for hypercoagulable state.
Anticoagulation
- Anticoagulation is recommended in all patients of BCS to prevent progression of the thrombosis.
- Anticoagulation with LMWH should be initiated without delay soon after diagnosis.The risk of associated bleeding complications is comparable to patients with anticoagulation therapy for other indications.
- Anticoagulation is maintained with a target value of Anti Xa between 0.5 and 0.8 IU/ml.
- The goal is to maintain INR between 2.5 and 3 monitored by regular INR testing.
- Prothrombin time and activated partial thromboplastin time are measured once anticoagulation is started and should be maintained within the therapeutic range.
- Before switching from LMWH to oral anticoagulants, all contraindications has to be ruled out and a complete diagnostic workup has to be completed.
Thrombolysis
- Thrombolytic agents include streptokinase, urokinase, recombinant tissue-type plasminogen activator (rt-PA).
- Local thrombolysis performed by an interventional radiologist is preferable over systemic thrombolysis.
- Systemic or intra-arterial thrombolysis in BCS has to be administered locally into the hepatic vein, inferior vena cava, and TIPS in case of acute thrombosis.