Budd-Chiari Syndrome Medication

Updated: Oct 10, 2018
  • Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

Medications commonly used in patients with Budd-Chiari syndrome include diuretics, anticoagulants, and thrombolytics. The therapeutic interventions used (medical or otherwise) must be tailored to each patient's condition. The use of thrombolytics should be reserved for experts familiar with the special circumstances in which they may be appropriate. The use of anticoagulants should be directed towards therapy of an underlying coagulopathy.

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Anticoagulants, Cardiovascular

Class Summary

These agents prevent recurrent or ongoing thromboembolic occlusion.

Warfarin (Coumadin, Jantoven)

Warfarin interferes with hepatic synthesis of vitamin K–dependent coagulation factors. It is used for the prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Tailor the dose to maintain an international normalized ratio (INR) in the range of 2-3.

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Antifibrinolytic Agents

Class Summary

Fibrinolytic drugs are used to dissolve a pathologic intraluminal thrombus or embolus that has not been dissolved by the endogenous fibrinolytic system. They are also used for the prevention of recurrent thrombus formation and for the rapid restoration of hemodynamic disturbances.

Urokinase

Urokinase is a direct plasminogen activator that acts on the endogenous fibrinolytic system and converts plasminogen to the enzyme plasmin, which, in turn, degrades fibrin clots, fibrinogen, and other plasma proteins. It is most often used for local fibrinolysis of thrombosed catheters and superficial vessels. An advantage to this agent is that it is nonantigenic. However, urokinase is more expensive than streptokinase, limiting its use. When it is used for local fibrinolysis, urokinase is administered as a local infusion directly into the area of the thrombus, with no bolus given. The dose should be adjusted to achieve clot lysis or patency of the affected vessel.

Alteplase (Activase)

Alteplase is a tissue plasminogen activator used in the management of acute myocardial infarction, acute ischemic stroke, and pulmonary embolism. Its safety and efficacy with concomitant administration of heparin or aspirin during the first 24 hours after symptom onset have not been investigated.

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Diuretic Agents

Class Summary

Diuretics can be useful to reduce the amount of ascites, providing symptomatic relief and reducing the need for paracentesis.

Spironolactone (Aldactone)

Spironolactone is a potassium-sparing diuretic. It competes with aldosterone for receptor sites in the distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions.

This agent is often preferred because of its potassium-sparing effects, particularly in a clinical setting that includes secondary hyperaldosteronism.

Furosemide (Lasix)

Furosemide increases the excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and the distal renal tubule.

Torsemide (Demadex)

Torsemide increases the excretion of water by interfering with the chloride-binding co-transport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. It increases the excretion of water, sodium, chloride, magnesium, and calcium. If a switch is made from intravenous to oral administration, an equivalent oral dose should be used. Doses vary depending on the patient's clinical condition.

Chlorothiazide (Diuril)

A thiazide diuretic, chlorothiazide inhibits sodium-chloride symport, blocking sodium reabsorption in the distal convoluted tubule.

Hydrochlorothiazide (Microzide)

Hydrochlorothiazide acts on the distal nephron to impair sodium reabsorption, enhancing sodium excretion. It has been in use for more than 40 years and is generally an important agent for the treatment of essential hypertension.

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