Safety And Clinical Efficacy Evaluation Of Warfarin Anticoagulation With Small Balloon Dilation For Treating Budd-Chiari Syndrome Complicated With Inferior Vena Cava Thrombosis

Objective: This study aims to evaluate the safety and clinical efficacy of warfarin anticoagulation after small balloon pre-dilation for treating Budd-Chiari syndrome (BCS) complicated with inferior vena cava (IVC) thrombosis. Methods: This prospective study analyzed the consecutive clinical data of 53 patients with BCS complicated with IVC thrombosis, who were admitted in our hospital from January 2000 to October 2015. Patients were divided into three groups: group A, warfarin anticoagulation alone (n=11); group B, warfarin anticoagulation after 6-mm balloon pre-dilation (n=17); group C, warfarin anticoagulation after 10-mm balloon pre-dilation (n=25). Patients were followed-up after discharge at 1, 3, 6, 9 and 12 months after pre-dilation or warfarin anticoagulation therapy. IVC patency and morphologic changes of the thrombus were examined by ultrasound, while clinical symptoms and signs were determined during follow-up. Individualized treatment programs for each patient were made according to follow-up results. Results: Small balloon pre-dilation therapy was successful in all cases (groups B and C). IVC angiography confirmed the thrombus in the IVC, but no floating thrombus was found. IVC pressure was measured before and after percutaneous transluminal angioplasty (PTA). Anticoagulation with warfarin was well-tolerated by all patients after small balloon pre-dilation. No bleeding complications and pulmonary embolism occurred during the follow-up. Conclusion: Warfarin anticoagulation with small balloon dilation made interventional treatment possible for BCS with IVC thrombosis. Small balloon pre-dilation with warfarin anticoagulation therapy (control international normalized ratio of 2-3) is a safe, feasible and effective treatment. In particular, 10-mm balloon pre-dilation appears to be more significant, and IVC thrombosis can dissolve within 12 months. This provides a foundation for percutaneous angioplasty of the IVC.