Feasibility of Anticoagulation in Patients of Budd-chiari Syndrome with Gastroesophageal Varices and Portal Hypertension

Abstract

AIM: Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction[1]. Patients with BCS are found to have oesophageal varices (OV), gastric varices (GV) as well as portal hypertensive gastropathy (PHG). Anticoagulation is recommended in BCS though not evaluated in randomized trials[2]. The aim of work is to determine feasibility of anticoagulation in patients with BCS with gastro-esophageal varices. METHODS: 150 patients with BCS were included. All had upper endoscopy. Band ligation was planned for (OV) with red signs or recent bleeding and cyanoacrylate injection for bleeding (GV) or signs of impending hemorrhage before anticoagulation. RESULTS: 30 patients (20%) were presented by GI bleeding, 12/30(40%) had large sized OV with (GV) in 3 of them, all had band ligation with cyanoacrylate injection of the (GV) before anticoagulation. The remaining 18 had PHG with medium sized non risky varices in 12/30 (40%) and small OV in 6/30 (20%). Only 2/30 (6.6%) had GI bleeding after anticoagulation with overall survival of 10.4 months. Among 120 patients who were not presented by GI bleeding, 18/120 (15%) had large OV, 57/120 (47.5%) had PHG with small or medium sized OV, one patient had isolated large (GV), and 44 patients had neither OV nor PHG. All were anticoagulated after band ligation of risky varices. 23 (19%) out of 120 died, only 3 (2.5%) due to GI bleeding with overall survival of 12.3 months. CONCLUSIONS: Anticoagulation in BCS is feasible after band ligation of large or medium sized OV with red signs. History of GI bleeding should not be a contraindication for anticoagulation in BCS.