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Portal vein thrombosis and Budd–Chiari syndrome

Thrombosis venae portae et syndroma Budd-Chiari · Trombóza vrátnicové žíly a Buddův–Chiariho syndrom

What it is

A clot in the vein carrying gut blood to the liver (portal vein) or in the veins draining the liver (Budd–Chiari); causes include cirrhosis, clotting disorders, blood cancers (JAK2), infection, pregnancy and the pill.

Symptoms & signs

  • Belly pain, fever
  • sudden swelling with fluid (ascites)
  • enlarged liver or spleen
  • vomiting blood from varices
  • often none, found on a scan

🚩 Get help if…

  • call 112 / 911 now Vomiting blood or black stools
  • call 112 / 911 now Severe belly pain with fever or collapse
  • see a doctor soon Swelling of the belly with belly pain
  • see a doctor soon Yellow skin or eyes

Where it strikes

Medical treatment

  • Doppler ultrasound or CT
  • Anticoagulation — reopens the vein in about half trials support
  • test for clotting disorders and JAK2
  • endoscopy to band varices
  • stent across the liver (TIPS) or liver transplant for Budd–Chiari that fails

Natural & lifestyle

  • Stop oestrogen pills after a clot
  • stay hydrated

Emerging & experimental

  • Direct oral anticoagulants in cirrhosis
  • recanalisation with TIPS

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Nattokinase or other 'natural blood thinners' in place of anticoagulants — unproven; bleeding with warfarin not confirmed in trials
  • Milk thistle — no effect on clots anecdotal / traditional

ICD codes