Effect of Direct Oral Anticoagulants Versus Traditional Anticoagulation in Budd-Chiari Syndrome

BackgroundThis systematic review aimed to evaluate the comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus traditional anticoagulants, including vitamin K antagonists (VKAs) and low-molecular-weight heparins (LMWHs), in the treatment of Budd-Chiari Syndrome (BCS).MethodsA comprehensive literature search was conducted in the PubMed and Embase databases up to July 2025. Studies were selected based on predefined inclusion criteria, focusing on patients with BCS who received DOACs (specifically dabigatran, rivaroxaban, apixaban, or edoxaban) compared to those treated with VKAs or LMWHs.ResultsOf 68 identified records, two retrospective studies met the inclusion criteria. Sharma et al (India, n = 98) compared dabigatran with VKAs after percutaneous endovascular intervention. Stent patency and major bleeding rates were similar between groups, with no difference in mortality, suggesting that dabigatran was noninferior to VKAs. Semmler et al (Austria, n = 43) compared DOACs with VKAs/LMWH in primary BCS patients, many with underlying myeloproliferative neoplasms. Over a median follow-up of 82.5 months, DOACs demonstrated comparable complete response rates and major bleeding risks. Both studies emphasized the convenience of DOACs due to oral administration and lack of INR monitoring.ConclusionCurrent evidence, though limited to small retrospective cohorts, suggests that DOACs may be as effective and safe as traditional anticoagulants in BCS management. DOACs offer practical advantages, particularly in patients with difficulties maintaining therapeutic INR or requiring long-term anticoagulation. Larger prospective studies and randomized controlled trials are warranted to validate these findings.