Portal vein thrombosis: an overview of current treatment options

Portal vein thrombosis (PVT) is a splanchnic vascular disorder characterised by a recent or chronic thrombotic occlusion of the portal venous system. Its aetiology is miscellaneous, and its management is demanding since PVT can play a critical role as far as morbidity and mortality are concerned. Indeed, PVT can develop as a complication of portal hypertension (PH), in association or not with advanced chronic liver disease, and aggravate its clinical consequences such as variceal bleeding and ascites. Furthermore, a diagnosis of PVT in a non-cirrhotic context can potentially reveal a previously unknown hypercoagulable condition, requiring further diagnostic steps and specific treatment in addition to anticoagulation. In addition to established therapeutic approaches, new strategies, including newer pharmacological treatments and interdisciplinary invasive procedures, gain more attention and have been increasingly introduced into clinical practice. This review aims at discussing the current knowledge in terms of treatment options for PVT.

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Direct-Acting Oral Anticoagulants (DOACs) in Cirrhosis and Cirrhosis-Associated Portal Vein Thrombosis

Seminars in Liver Disease ◽

10.1055/s-0039-1679934 ◽

2019 ◽

Vol 39 (02) ◽

pp. 195-208 ◽

Cited By ~ 9

Author(s):

Ethan Weinberg ◽

Julia Palecki ◽

K. Reddy

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Treatment Guidelines ◽

Oral Anticoagulants ◽

Primary Prophylaxis ◽

Current Treatment ◽

Vein Thrombosis ◽

Increased Risk ◽

Direct Acting ◽

Direct Acting Oral Anticoagulants

AbstractDirect-acting oral anticoagulants (DOACs) have provided benefit in patients requiring anticoagulation for certain diseases by decreasing the burden of subcutaneous injections and the requirement for frequent monitoring through regular blood tests, to ensure adequacy of the therapeutic doses. Studies have demonstrated DOACs to be as safe, and in some instance safer, compared with traditional anticoagulants in the general population. However, the studies evaluating DOACs excluded patients with cirrhosis, a condition associated with an increased risk of developing portal vein thrombosis (PVT). Warfarin or low-molecular weight heparin are the standard-of-care treatment for acute PVT in cirrhosis, although there is enthusiasm in a paradigm shift switching to DOACs for the treatment of acute PVT in cirrhosis, particularly since the release of DOAC antidotes. This article reviews the current Food and Drug Administration-approved DOACs, hepatic metabolism of DOACs, pharmacokinetics of DOACs in patients with cirrhosis, safety of DOACs (including bleeding, hepatotoxicity, and pregnancy), current treatment guidelines for PVT in cirrhosis, and studies evaluating the use of DOACs in cirrhosis and for the treatment of PVT in cirrhosis. The potential use of DOACs for PVT primary prophylaxis in at-risk patients with cirrhosis and the possible antifibrotic effects of DOACs are also discussed.

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Portal Vein Thrombosis In Cirrhosis: Interventional Treatment Options

Current Gastroenterology Reports ◽

10.1007/s11894-021-00826-1 ◽

2021 ◽

Vol 23 (12) ◽

Author(s):

Christopher Molvar ◽

Parag Amin

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Treatment Options ◽

Interventional Treatment ◽

Vein Thrombosis

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Portal Venous Thrombosis in a Special Operations Paratrooper: A Case Report

Military Medicine ◽

10.1093/milmed/usab387 ◽

2021 ◽

Author(s):

Rachel E Bridwell ◽

Sean Clerkin ◽

Nathaniel R Walker ◽

Brit Long ◽

Sarah Goss

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal System ◽

Thrombotic Occlusion ◽

Special Operations ◽

Vein Thrombosis ◽

Portal Venous Thrombosis ◽

Abdominal Infections

ABSTRACT Portal vein thrombosis is the thrombotic occlusion of the extrahepatic portal system, which can propagate towards the vena caval system. Although rare, it occurs primarily in those with cirrhosis, intra-abdominal infections, malignancy, or hypercoagulable disorders. This report describes the first reported case of a soldier within special operations without identifiable risk factors who was found to have a completely occlusive portal vein thrombosis after approximately 10 days of insidious abdominal pain. This case emphasizes the importance of considering this rare but dangerous pathology among this highly screened and capable special operations population.

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Radioembolization for hepatocellular carcinoma with portal vein thrombosis: Impact of liver function on systemic treatment options at disease progression

Journal of Hepatology ◽

10.1016/j.jhep.2012.09.003 ◽

2013 ◽

Vol 58 (1) ◽

pp. 73-80 ◽

Cited By ~ 71

Author(s):

Khairuddin Memon ◽

Laura Kulik ◽

Robert J. Lewandowski ◽

Mary F. Mulcahy ◽

Al B. Benson ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Portal Vein ◽

Disease Progression ◽

Portal Vein Thrombosis ◽

Systemic Treatment ◽

Treatment Options ◽

Vein Thrombosis

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New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1715473 ◽

2020 ◽

Vol 46 (06) ◽

pp. 673-681 ◽

Cited By ~ 1

Author(s):

Oana Nicoară-Farcău ◽

Guillem Soy ◽

Marta Magaz ◽

Anna Baiges ◽

Fanny Turon ◽

...

Keyword(s):

Risk Factors ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Current Knowledge ◽

Current Evidence ◽

Special Focus ◽

Vein Thrombosis ◽

Frequent Event ◽

Intrahepatic Portosystemic Shunt ◽

History Of

AbstractPortal vein thrombosis (PVT) is a frequent event in patients with cirrhosis regardless of etiology. Notwithstanding the commonality of the problem, the pathophysiology and risk factors for PVT in cirrhosis are largely unknown. The clinical impact of PVT in the natural history of cirrhosis is unclear, indications for PVT treatment are not well defined, and treatment recommendations are based on experts' opinion and consensus only. Therefore, this review aims to summarize current knowledge of mechanisms and risk factors for PVT development and assess the current evidence of PVT management, with a special focus on strategies of anticoagulation and transjugular intrahepatic portosystemic shunt placement.

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Current knowledge and management of portal vein thrombosis in cirrhosis

Journal of Hepatology ◽

10.1016/j.jhep.2021.04.029 ◽

2021 ◽

Author(s):

Marco Senzolo ◽

Guadalupe Garcia-Tsao ◽

Juan Carlos García-Pagán

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Current Knowledge ◽

Vein Thrombosis

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Management of Anticoagulation for Portal Vein Thrombosis in Individuals with Cirrhosis: A Systematic Review

International Journal of Hepatology ◽

10.1155/2012/672986 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 29

Author(s):

Geneviève Huard ◽

Marc Bilodeau

Keyword(s):

Systematic Review ◽

Liver Cirrhosis ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Current Knowledge ◽

Vein Thrombosis ◽

Advantages And Disadvantages ◽

Risk Of Bleeding ◽

Coagulation Abnormalities ◽

Increased Risk

Non-neoplastic portal vein thrombosis (PVT) is an increasingly recognized complication of liver cirrhosis. It is often diagnosed fortuitously and can be either partial or complete. The clinical significance of PVT is not obvious except in some situations such as when patients are on the waiting list for liver transplantation. The only known therapy is anticoagulation which has been shown to permit the disappearance of thrombosis and to prevent further extension. Anticoagulation is a challenging therapy in individuals with liver cirrhosis because of the well-recognized coagulation abnormalities observed in that setting and because of the increased risk of bleeding, especially from gastrointestinal tract caused by portal hypertension. We herein review the current knowledge on that topic in order to highlight the advantages and disadvantages of the currently proposed therapeutic attitudes in face of the diagnosis of PVT in individuals with cirrhosis.

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Management of Portal and Mesenteric Venous Thrombosis

Digestive Disease Interventions ◽

10.1055/s-0040-1712119 ◽

2020 ◽

Vol 04 (02) ◽

pp. 122-133

Author(s):

Joshua A. Turkeltaub ◽

Michael Kriss

Keyword(s):

Risk Factors ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Mesenteric Ischemia ◽

Treatment Options ◽

Rare Condition ◽

Mesenteric Venous Thrombosis ◽

Vein Thrombosis ◽

Clinical Considerations ◽

Transplant Candidates

AbstractPortal vein thrombosis is a rare condition seen in the general population, though is more prevalent in certain populations with thrombophilia as well as in patients with cirrhosis. Because morbidity and mortality can be significant with portal vein thrombosis, diagnosis and appropriate management are crucial. In noncirrhotic patients, untreated portal vein thrombosis can result in mesenteric ischemia and complications of portal hypertension. In cirrhosis, portal vein thrombosis is often incidentally found on routine screening imaging, and the treatment outside of transplant candidates is more controversial. In this review, we will outline risk factors for portal vein thrombosis, discuss indications for treatment, and evaluate both pharmacological and endovascular treatment options, highlighting unique clinical considerations dependent on the presence or absence of cirrhosis.

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