Premium
Anticoagulating Budd–Chiari syndrome patients presenting with variceal bleed: A retrospective study
Author(s) -
Sharma Anand,
Goel Ashish,
Moses Vinu,
Keshava Shyamkumar Nidugala,
Zachariah Uday George,
Elias Elwyn,
Eapen Chundamannil Eapen
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14971
Subject(s) - medicine , budd–chiari syndrome , surgery , bleed , stent , ascites , sclerotherapy , retrospective cohort study , inferior vena cava , varices , angioplasty , cirrhosis
Background and Aim This aims to study incidence of re‐bleeding on anticoagulation and survival of Budd–Chiari syndrome (BCS) patients presenting with variceal bleeding. Methods Budd–Chiari syndrome patients presenting with variceal bleed between 01/01/2007 and 01/05/2019 were retrospectively studied. Patients underwent endoscopic treatment ± endovascular therapy, followed by anticoagulation. Variceal re‐bleed (on anticoagulation) and survival were studied. Results Of 376 BCS patients diagnosed during the study period, 40 (10.7%) patients, presenting with variceal bleed (age 33 [25–40] years; male patients 70%; Rotterdam score 1.13 [0.63–1.22]), Group 1 were compared with 40 randomly selected age‐matched BCS patients presenting with ascites, no bleeds (40 [23–42] years; male patients 42.5%; Rotterdam score 1.11 [1.09–1.16]), Group 2. The commonest site of obstruction was hepatic vein (65%) in Group 1 and combined hepatic veins and inferior vena cava (57.5%) in Group 2 ( P < 0.01). Thirty‐six Group 1 patients underwent endoscopic intervention (variceal ligation, 33; sclerotherapy, 2; glue injection, 1). Endovascular intervention was performed in 30 Group 1 patients (angioplasty ± stent, 22; endovascular shunt, 8) and in 34 Group 2 patients (angioplasty ± stent, 26; endovascular shunt, 8). All 80 patients were started on anticoagulation. Variceal bleed on anticoagulation occurred in five patients in Group 1 and three patients in Group 2. One‐year and 5‐year survival were 94.2% and 87.5%, respectively, in Group 1 and 100% and 80%, respectively, in Group 2. Conclusions About one‐tenth of BCS patients present with variceal bleed. On management with endoscopic ± endovascular therapy, followed by anticoagulation, variceal re‐bleed in these patients were comparable with those in BCS patients presenting with ascites and survival was excellent at 1 and 5 years.