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. 1994 Jul;35(7):1004–1006. doi: 10.1136/gut.35.7.1004

Budd-Chiari syndrome in a young patient with anticardiolipin antibodies: need for prolonged anticoagulant treatment.

R J Ouwendijk 1, J C Koster 1, J H Wilson 1, J Stibbe 1, J S Lameris 1, W Visser 1, J P Benhamou 1
PMCID: PMC1374853  PMID: 8063206

Abstract

The case of a 20 year old woman is reported with Budd-Chiari syndrome in whom lupus anticoagulant and anticardiolipin antibodies were shown; treatment with oral anticoagulants induced a considerable improvement. This treatment was interrupted after one year; interruption was followed by redevelopment of ascites. Further treatment with anticoagulants was continued for five years with noticeable improvement. When treatment with oral anticoagulants was stopped because of pregnancy, the patient redeveloped ascites and had a spontaneous miscarriage. Subsequently, treatment with oral anticoagulants was reintroduced and again resulted in noticeable improvement. In conclusion patients with Budd-Chiari syndrome should be tested for lupus anticoagulants and anticardiolipin antibodies, Budd-Chiari syndrome resulting from this cause may have a good response to treatment with oral anticoagulants; this treatment should be maintained permanently, and pregnancy in such patients may initiate serious difficulties.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Branch D. W., Scott J. R., Kochenour N. K., Hershgold E. Obstetric complications associated with the lupus anticoagulant. N Engl J Med. 1985 Nov 21;313(21):1322–1326. doi: 10.1056/NEJM198511213132104. [DOI] [PubMed] [Google Scholar]
  2. Carreras L. O., Defreyn G., Machin S. J., Vermylen J., Deman R., Spitz B., Van Assche A. Arterial thrombosis, intrauterine death and "lupus" antiocoagulant: detection of immunoglobulin interfering with prostacyclin formation. Lancet. 1981 Jan 31;1(8214):244–246. doi: 10.1016/s0140-6736(81)92087-0. [DOI] [PubMed] [Google Scholar]
  3. Disney T. F., Sullivan S. N., Haddad R. G., Lowe D., Goldbach M. M. Budd-Chiari syndrome with inferior vena cava obstruction associated with systemic lupus erythematosus. J Clin Gastroenterol. 1984 Jun;6(3):253–256. [PubMed] [Google Scholar]
  4. Espinoza L. R., Jara L. J., Silveira L. H., Martínez-Osuna P., Zwolinska J. B., Kneer C., Aguilar J. L. Anticardiolipin antibodies in polymyalgia rheumatica-giant cell arteritis: association with severe vascular complications. Am J Med. 1991 Apr;90(4):474–478. [PubMed] [Google Scholar]
  5. Exner T., Rickard K. A., Kronenberg H. A sensitive test demonstrating lupus anticoagulant and its behavioural patterns. Br J Haematol. 1978 Sep;40(1):143–151. doi: 10.1111/j.1365-2141.1978.tb03648.x. [DOI] [PubMed] [Google Scholar]
  6. Gastineau D. A., Kazmier F. J., Nichols W. L., Bowie E. J. Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Hematol. 1985 Jul;19(3):265–275. doi: 10.1002/ajh.2830190308. [DOI] [PubMed] [Google Scholar]
  7. Gupta S., Blumgart L. H., Hodgson H. J. Budd-Chiari syndrome: long-term survival and factors affecting mortality. Q J Med. 1986 Aug;60(232):781–791. [PubMed] [Google Scholar]
  8. Harris E. N., Chan J. K., Asherson R. A., Aber V. R., Gharavi A. E., Hughes G. R. Thrombosis, recurrent fetal loss, and thrombocytopenia. Predictive value of the anticardiolipin antibody test. Arch Intern Med. 1986 Nov;146(11):2153–2156. [PubMed] [Google Scholar]
  9. Harris E. N., Gharavi A. E., Boey M. L., Patel B. M., Mackworth-Young C. G., Loizou S., Hughes G. R. Anticardiolipin antibodies: detection by radioimmunoassay and association with thrombosis in systemic lupus erythematosus. Lancet. 1983 Nov 26;2(8361):1211–1214. doi: 10.1016/s0140-6736(83)91267-9. [DOI] [PubMed] [Google Scholar]
  10. Ilan Y., Oren R., Shouval D. Postpartum Budd-Chiari syndrome with prolonged hypercoagulability state. Am J Obstet Gynecol. 1990 May;162(5):1164–1165. doi: 10.1016/0002-9378(90)90007-t. [DOI] [PubMed] [Google Scholar]
  11. Khamashta M. A., Cervera R., Asherson R. A., Font J., Gil A., Coltart D. J., Vázquez J. J., Paré C., Ingelmo M., Oliver J. Association of antibodies against phospholipids with heart valve disease in systemic lupus erythematosus. Lancet. 1990 Jun 30;335(8705):1541–1544. doi: 10.1016/0140-6736(90)91373-i. [DOI] [PubMed] [Google Scholar]
  12. Khuroo M. S., Datta D. V. Budd-Chiari syndrome following pregnancy. Report of 16 cases, with roentgenologic, hemodynamic and histologic studies of the hepatic outflow tract. Am J Med. 1980 Jan;68(1):113–121. doi: 10.1016/0002-9343(80)90180-1. [DOI] [PubMed] [Google Scholar]
  13. Lalonde G., Théoret G., Daloze P., Bettez P., Katz S. S. Inferior vena cava stenosis and Budd--Chiari syndrome in a woman taking oral contraceptives. Gastroenterology. 1982 Jun;82(6):1452–1456. [PubMed] [Google Scholar]
  14. Lockshin M. D., Druzin M. L., Goei S., Qamar T., Magid M. S., Jovanovic L., Ferenc M. Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med. 1985 Jul 18;313(3):152–156. doi: 10.1056/NEJM198507183130304. [DOI] [PubMed] [Google Scholar]
  15. Pomeroy C., Knodell R. G., Swaim W. R., Arneson P., Mahowald M. L. Budd-Chiari syndrome in a patient with the lupus anticoagulant. Gastroenterology. 1984 Jan;86(1):158–161. [PubMed] [Google Scholar]
  16. Reece E. A., Gabrielli S., Cullen M. T., Zheng X. Z., Hobbins J. C., Harris E. N. Recurrent adverse pregnancy outcome and antiphospholipid antibodies. Am J Obstet Gynecol. 1990 Jul;163(1 Pt 1):162–169. doi: 10.1016/s0002-9378(11)90692-9. [DOI] [PubMed] [Google Scholar]
  17. Rosove M. H., Brewer P. M. Antiphospholipid thrombosis: clinical course after the first thrombotic event in 70 patients. Ann Intern Med. 1992 Aug 15;117(4):303–308. doi: 10.7326/0003-4819-117-4-303. [DOI] [PubMed] [Google Scholar]
  18. Silveira L. H., Hubble C. L., Jara L. J., Saway S., Martínez-Osuna P., Seleznick M. J., Angel J., O'Brien W., Espinoza L. R. Prevention of anticardiolipin antibody-related pregnancy losses with prednisone and aspirin. Am J Med. 1992 Oct;93(4):403–411. doi: 10.1016/0002-9343(92)90170-g. [DOI] [PubMed] [Google Scholar]
  19. Terabayashi H., Okuda K., Nomura F., Ohnishi K., Wong P. Transformation of inferior vena caval thrombosis to membranous obstruction in a patient with the lupus anticoagulant. Gastroenterology. 1986 Jul;91(1):219–224. doi: 10.1016/0016-5085(86)90462-2. [DOI] [PubMed] [Google Scholar]
  20. Triplett D. A., Harris E. N. Antiphospholipid antibodies and reproduction. Am J Reprod Immunol. 1989 Nov-Dec;21(3-4):123–131. doi: 10.1111/j.1600-0897.1989.tb01016.x. [DOI] [PubMed] [Google Scholar]
  21. Valla D., Casadevall N., Lacombe C., Varet B., Goldwasser E., Franco D., Maillard J. N., Pariente E. A., Leporrier M., Rueff B. Primary myeloproliferative disorder and hepatic vein thrombosis. A prospective study of erythroid colony formation in vitro in 20 patients with Budd-Chiari syndrome. Ann Intern Med. 1985 Sep;103(3):329–334. doi: 10.7326/0003-4819-103-3-329. [DOI] [PubMed] [Google Scholar]
  22. Valla D., Le M. G., Poynard T., Zucman N., Rueff B., Benhamou J. P. Risk of hepatic vein thrombosis in relation to recent use of oral contraceptives. A case-control study. Gastroenterology. 1986 Apr;90(4):807–811. doi: 10.1016/0016-5085(86)90855-3. [DOI] [PubMed] [Google Scholar]
  23. Van Steenbergen W., Beyls J., Vermylen J., Fevery J., Marchal G., Desmet V., De Groote J. 'Lupus' anticoagulant and thrombosis of the hepatic veins (Budd-Chiari syndrome). Report of three patients and review of the literature. J Hepatol. 1986;3(1):87–94. doi: 10.1016/s0168-8278(86)80151-9. [DOI] [PubMed] [Google Scholar]
  24. Vons C., Smadja C., Franco D., Valla D., Rueff B., Benhamou J. P. Successful pregnancy after Budd-Chiari syndrome. Lancet. 1984 Oct 27;2(8409):975–975. doi: 10.1016/s0140-6736(84)91181-4. [DOI] [PubMed] [Google Scholar]
  25. Wade J. C., Gaffey M., Wiernik P. H., Schimpff S. C., Schiffer C. A., Wesley M., Hoofnagle J. H. Hepatitis in patients with acute nonlymphocytic leukemia. Am J Med. 1983 Sep;75(3):413–422. doi: 10.1016/0002-9343(83)90342-x. [DOI] [PubMed] [Google Scholar]

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