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Topics:
General Hepatology • Hepatology
What is your approach in deciding when to start (or briefly defer) anticoagulation in newly diagnosed Budd–Chiari syndrome with large esophageal varices and very recent banding?
What specific bedside thresholds (ex: ongoing bleeding, platelet count, etc.) push you toward immediate anticoagulation versus early portal decompression (ex: TIPS) instead?
Answer from: at Academic Institution
Generally, we start IV heparin immediately, even if recent banding performed. Bleeding from varices is caused by transmural pressure, not anticoagulation. So interventions to address portal pressure should be prioritized, including anticoagulation and TIPS as soon as feasible.
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