Portal vein thrombosis: A concise review (Review)

Abstract

Portal vein thrombosis (PVT) is a frequent complication in cirrhotic patients, but it may also exist as a basic vascular condition even without any liver damage. Local and systemic factors play a significant role in the pathogenesis of PVT; yet, in practice, more than one factor may be identified. PVT can be considered a result of liver fibrosis and hepatic insufficiency. The JAK2 mutation has been accepted as a factor producing PVT. In general, the anticoagulants are recommended but this therapy should be used carefully in treating patients that associate coagulopathy or thrombocytopenia and esophageal varices. Acute PVT without bowel infarction has a good prognosis. In liver cirrhosis, the mortality due to hemorrhage is higher than in chronic PVT. Therefore, for the patients with PVT, the survival rate is decreased by 55% in two years, due to hepatic insufficiency. Regarding the treatment, LMWH (low molecular weight heparine) is the most utilized in patients with cirrhosis, non-malignancies, infections, or those who are awaiting a liver transplant. DOACs (direct-acting oral anticoagulants) may be used in the rest of the medical conditions, being safe and equal to LMWH.

Portal vein thrombosis: Before, during, and after liver transplant

“…[5] Contrasted MRI can further determine flow within the portal venous system and assess for cavernoma presence. [5] The prevalence of prothrombic mutations and conditions such as JAK2 mutation, factor V Leiden, and paroxysmal nocturnal hemoglobinuria are more common in patients with cirrhosis who develop PVT than patients with cirrhosis who do not develop PVT. Despite this finding, there is no specific guidance to pursue a hypercoagulability workup in this patient population given the provoked nature of PVT formation in the setting of cirrhosis-associated hypercoagulability derangements.…”

“…Cases of PVT warrant a screening endoscopy within 2-3 months of diagnosis to assess variceal burden in need of eradication. [5,6] Once screened, treatment should be offered in cases of acute PVT. In cases of chronic PVT, it is reasonable to discuss with the multidisciplinary transplant team regarding the benefits and risks of anticoagulation.…”

Differentiation of malignant from non-malignant portal vein thrombosis in liver cirrhosis: the challenging dilemma

“…Finally, it is not uncommon to find portal vein thrombosis in patients with advanced liver cirrhosis, despite the fact that malignant variant is the most frequent as the hepatic microenvironment become more prone to carcinogenesis [49,50], but efforts should be gathered to exclude benign PVT which may change the management of the patients dramatically.…”

Safety of anticoagulation use for treatment of portal vein thrombosis in liver cirrhosis and its effect on hospital-based outcomes: an insight from a US nationwide database

“…Portal vein thrombosis (PVT) is a rare condition defined as the presence of a blood clot in the portal vein extending to its intrahepatic or extrahepatic branches, resulting in partial or complete obstruction. Its reported incidence in the general population is 0.05%–0.5%; however, it is between 5% and 18% in patients with advanced liver disease with decompensated cirrhosis 1. Historically, cirrhosis is considered an autocoagulant state; however, due to haemodynamic changes resulting from advanced cirrhosis, cirrhosis can lead to bleeding and thrombotic events 2.…”