Budd-Chiari syndrome is a recognised cause of acute liver failure (ALF). When ALF develops in this setting, management follows a distinct clinical pathway that addresses the underlying aetiology — and differs meaningfully from other causes of ALF.
In patients with Budd-Chiari syndrome-induced ALF, anticoagulation is recommended as the initial step in the absence of contraindications. The clinical course and the response to initial therapy determine the next stage of management. Selection of subsequent interventions depends on individual patient factors and the specific anatomical pattern of obstruction.
When initial therapy is insufficient, the protocol involves interventional approaches aimed at portal decompression, including a minimally invasive shunting procedure. Revascularisation strategies may also be considered depending on the underlying anatomical cause. The complete selection criteria, sequencing, and escalation pathway are available in the full protocol.
DOI: 10.14309/ajg.0000000000002340