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Efficacy and Safety of Direct Oral Anticoagulants in Budd-Chiari Syndrome After Percutaneous Recanalization

Chengjian Wu1, Yi Shen1, Zhaoyan Gao2

  • 1Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|October 16, 2025
PubMed

Insights

Direct oral anticoagulants (DOACs) show promise as a safe and effective alternative to vitamin K antagonists (VKAs) for Budd-Chiari syndrome patients post-recanalization. These findings suggest DOACs may offer comparable efficacy and safety in managing this rare thrombotic disorder.

Area of Science:

  • Hepatology
  • Vascular Medicine
  • Pharmacology

Background:

  • Budd-Chiari syndrome (BCS) is a rare hepatic venous outflow obstruction.
  • Limited data exist on direct oral anticoagulants (DOACs) for BCS management.
  • Percutaneous recanalization is a key intervention for BCS.

Purpose of the Study:

  • To evaluate the efficacy and safety of DOACs versus vitamin K antagonists (VKAs) in BCS patients.
  • To assess patency rates and bleeding events after percutaneous recanalization in BCS.
  • To provide evidence for DOAC use in this specific patient population.

Main Methods:

  • Retrospective single-center analysis of 236 primary BCS patients.
  • Comparison of DOACs (rivaroxaban, dabigatran) versus VKAs.
  • Primary endpoints: cumulative primary and secondary patency rates.
  • Secondary endpoints: bleeding events and mortality.

Main Results:

  • No significant difference in 1-, 2-, or 3-year cumulative primary patency rates between DOAC and VKA groups (p=0.269).
  • Similar major bleeding rates observed between DOAC and VKA groups (p=0.436).
  • DOAC group: 133 patients; VKA group: 103 patients.

Conclusions:

  • DOACs represent a potentially effective and safe alternative to VKAs for BCS patients post-percutaneous recanalization.
  • Findings suggest DOACs can be considered for anticoagulation in BCS.
  • Further prospective studies are warranted to validate these results.
Abstract

Keywords:
Budd–Chiari syndromeanticoagulationdirect oral anticoagulantspercutaneous recanalizationvascular liver disordervitamin K antagonists

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