Budd-Chiari syndrome medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*The therapy for Budd-Chiari syndrome is aimed at alleviating the obstruction.Underlying conditions are aggressively treated. | *The therapy for Budd-Chiari syndrome is aimed at alleviating the obstruction.Underlying conditions are aggressively treated.<ref name="pmid24923240">{{cite journal |vauthors=Copelan A, Remer EM, Sands M, Nghiem H, Kapoor B |title=Diagnosis and management of Budd Chiari syndrome: an update |journal=Cardiovasc Intervent Radiol |volume=38 |issue=1 |pages=1–12 |year=2015 |pmid=24923240 |doi=10.1007/s00270-014-0919-9 |url=}}</ref><ref name="pmid23742773">{{cite journal |vauthors=Sun YL, Fu Y, Zhou L, Ma XX, Wang ZW, Wu Y |title=Staged management of Budd-Chiari syndrome caused by co-obstruction of the inferior vena cava and main hepatic veins |journal=HBPD INT |volume=12 |issue=3 |pages=278–85 |year=2013 |pmid=23742773 |doi= |url=}}</ref> | ||
*Patients with Budd-Chiari syndrome are treated according to the severity of the disease.Treatment options include: | *Patients with Budd-Chiari syndrome are treated according to the severity of the disease.Treatment options include: | ||
**Initial Medical therapy | **Initial Medical therapy | ||
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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.[1][2]
- 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.
References
- ↑ Copelan A, Remer EM, Sands M, Nghiem H, Kapoor B (2015). "Diagnosis and management of Budd Chiari syndrome: an update". Cardiovasc Intervent Radiol. 38 (1): 1–12. doi:10.1007/s00270-014-0919-9. PMID 24923240.
- ↑ Sun YL, Fu Y, Zhou L, Ma XX, Wang ZW, Wu Y (2013). "Staged management of Budd-Chiari syndrome caused by co-obstruction of the inferior vena cava and main hepatic veins". HBPD INT. 12 (3): 278–85. PMID 23742773.