An approach to initial management of Budd-Chiari syndrome

HCC: hepatocellular carcinoma; TIPS: transjugular intrahepatic portosystemic shunt.

* For patients with gastroesophageal varices who are at risk for bleeding, we implement measures to prevent bleeding prior to starting anticoagulation. We typically use a nonselective beta blocker for prophylaxis. Refer to UpToDate content on prevention of variceal bleeding for additional details.

¶ Contraindications to thrombolytic therapy include large gastroesophageal varices and/or gastrointestinal bleeding.

Δ Disease progression includes the development of cirrhosis and its complications (eg, portal hypertension, HCC) and progression of an underlying myeloproliferative disorder.

◊ The choice of intervention is informed by several factors including technical feasibility for TIPS, candidacy for liver transplantation, underlying prothrombotic disorder, and local expertise. When feasible, TIPS is more commonly performed than surgical shunt because it is less invasive and is effective for patients who have not responded to other therapies. Liver transplantation may be an option for patients who develop decompensated cirrhosis and have not responded to endovascular intervention and anticoagulation.