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Bleeding in patients with Budd-Chiari syndrome
Pierre-Emmanuel Rautou1, Ludivine Douarin, Marie-Hélène Denninger
1Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, France.
Journal of Hepatology
|October 5, 2010
Summary
Major bleeding is frequent in Budd-Chiari syndrome (BCS) patients on anticoagulation. Invasive procedures and portal hypertension are key risks, with BCS severity impacting prognosis.
Area of Science:
- Hepatology
- Gastroenterology
- Vascular Medicine
Background:
- Anticoagulation therapy is standard for Budd-Chiari syndrome (BCS).
- Assessing major bleeding incidence, severity, and risk factors in BCS patients on anticoagulation is crucial.
Purpose of the Study:
- To evaluate the incidence, severity, and risk factors of major bleeding in patients with Budd-Chiari syndrome (BCS) undergoing anticoagulation therapy.
Main Methods:
- A cohort of 94 consecutive BCS patients was evaluated.
- Major bleeding was defined by hospitalization, transfusion needs, or critical location (intracranial, retroperitoneal, fatal).
Main Results:
- Over 43 months, 47 patients experienced 92 major bleeding episodes (22.8 per 100 patient-years).
- Invasive procedures (40 episodes) and gastrointestinal bleeding (26 episodes, 15 linked to portal hypertension) were common causes.
- Esophageal varices independently predicted bleeding unrelated to invasive therapy; baseline BCS severity determined prognosis.
Conclusions:
- Major bleeding is a significant complication in BCS patients receiving anticoagulation.
- Invasive procedures and portal hypertension are primary bleeding drivers; anticoagulation intensity is secondary.
- Reducing anticoagulation during invasive therapy and enhancing portal hypertension prophylaxis may improve outcomes.
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