Direct oral anticoagulants for the treatment of splanchnic vein thrombosis: A state of art

Table 2 Comparison of main clinical practice guidelines for the management of portal vein thrombosis in non-cirrhotic patients

	EASL 2016[30]	AASLD 2020[38]	ACG 2020[52]	Baveno VII 2022[35]
Classification	Acute; Chronic	Recent: < 6 mo; Chronic: > 6 mo	Acute; Chronic	Recent: < 6 mo; Chronic: > 6 mo
Treatment	Acute: AC; Chronic: Not specified	Recent PVT: AC; Chronic complete PVT or cavernous transformation: No benefit from AC	Acute PVT: AC; Chronic: thrombophilia, progression of thrombus into mesenteric veins, current or previous evidence of bowel ischemia	Recent PVT: At diagnosis; Chronic PVT: After prophylaxis for portal hypertensive bleeding in high-risk varices
Choice of anticoagulation	LMWH, VKA	LMWH, VKA, DOACs	UFH, LMWH for initiation; LMWH or VKA for maintenance (DOACs absorption limited in the presence of intestinal oedema)	LMWH, VKA, DOACs
Duration of treatment	At least 6 mo in presence of transient risk factor; long term for persistent risk factor or in case of chronic PVT with history of intestinal ischemia or recurrent thrombosis	AC for 3 mo	At least 6 mo for acute without thrombophilia; long term with thrombophilia	Recent PVT: At least 6 mo; Chronic: Long term for patient with permanent prothrombotic state
Notes				EVL can be performed safely without withdrawing VKA

AASLD: American Association for the Study of Liver Diseases; AC: Anticoagulation; ACG: American College of Gastroenterology; DOACs: Direct oral anticoagulants; EASL: European Association for the Study of the Liver; EVL: Endoscopic variceal ligation; LMWH: Low molecular weight heparin; PVT: Portal vein thrombosis; UFH: Unfractioned heparin; VKA: Vitamin K antagonists.