Budd-Chiari Syndrome: Illustrated Review of Current Management

John D. Horton; Francisco L. San Miguel; Jorge A. Ortiz

Disclosures

Liver International. 2008;28(4):455-466. 

In This Article

Medical Management

Medical management consists of anticoagulation, sodium restriction, diuretic therapy and paracentesis. Anticoagulation can be achieved with heparin in the acute setting and with warfarin for long-term treatment. Sodium should be restricted to approximately 60-90mEq/day (1500-2000mg of salt). Moderate ascites can be treated with oral diuretics such as furosemide (20-40mg/day) and spironolactone (50-200mg/day). Patients with symptomatic large-volume ascites can undergo periodic abdominal paracentesis.[16] Some clinicians recommend medical therapy alone for patients with few symptoms, relatively normal liver-function tests and easily controlled ascites.[13]

A report by McCarthy in 1985 showed that medical management alone resulted in death within 6 months in 12 of 14 patients.[28] However, Khuroo reported more promising results from a case series where 8 of 20 patients treated with medical therapy alone had significant clinical and biochemical improvement with 53% of all medically treated patients alive after 24 months.[29] Both these studies were retrospective case series from a single institution.

Plessier reported their experience with 51 cases of BCS and found that nine of their patients were successfully treated with medical therapy alone. Interestingly, this study found a 15% rate of heparin-induced thrombocytopaenia, which is 10-fold higher than the rates from large clinical trials.[27]

For patients who present with BCS several months after liver transplantation, medical management may be a viable option. Parrilla's series reported that only three out of 1112 transplants suffered delayed hepatic outflow obstruction, and all three patients were successfully managed with diuretics for control of their ascites.[7]

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