Factor V Leiden related Budd-Chiari syndrome. Issue 2 (1st February 2001)

• Record Type: Journal Article
• Authors: Deltenre, P; Denninger, M-H; Hillaire, S; Guillin, M-C; Casadevall, N; Brière, J; Erlinger, S; Valla, D-C
• Is Part Of: Gut. Volume 48:Issue 2(2001)
• Page Start: 264
• Page End: 268
• Publication Date: 2001-02-01
• Subjects: thrombophilia -- Budd-Chiari syndrome -- inferior vena cava obstruction -- myeloproliferative disorders -- ischaemic necrosis; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gut.48.2.264
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : BACKGROUND: The role of factor V Leiden as a cause of Budd-Chiari syndrome has only recently been described. AIMS: To assess the specific features of factor V Leiden related Budd-Chiari syndrome. PATIENTS: Sixty three consecutive patients with hepatic vein or terminal inferior vena cava thrombosis. METHODS: Standardised chart review. RESULTS: Factor V Leiden was found in 20 patients (31% (95% CI 20–43)). In the subgroup of patients with, compared with the subgroup without, factor V Leiden, a combination of prothrombotic states was more common (70% (95% CI 50–90) v 14% (95% CI 3–24)); inferior vena cava thrombosis was more frequent (40% (95% CI 19–61) v 7% (95% CI 0–14)); and distribution of initial alanine aminotransferase values was bimodal (almost normal or extremely increased) versus unimodal (p=0.003). Factor V Leiden accounted for four of five cases of massive ischaemic necrosis (transaminases >50-fold the upper limit of normal values) (p=0.014), and also for all three cases developing during pregnancy. Patients with and without factor V Leiden did not differ with regard to mortality, portosytemic shunting, or listing for liver transplantation. Hepatocellular carcinoma developed in two patients; both had factor V Leiden and indolent obstruction of the inferior vena cava. CONCLUSIONS: In patients with Budd-Chiari syndrome, factor V Leiden (a) is common; (b) precipitates thrombosis mostly when combined with another risk factor; (c) is associated with one of two contrasting clinical pictures: indolent thrombosis—particularly of the inferior vena cava—or massive ischaemic necrosis; and (d) is a major cofactor of Budd-Chiari syndrome developing during pregnancy.