Portal vein thrombosis in cirrhosis: Controversies and latest developments

Abstract

Portal vein thrombosis (PVT) is encountered in liver cirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus publication. We review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation, and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%. PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions.

Keywords: Portal vein thrombosis; Liver cirrhosis; Anticoagulation; Transjugular intrahepatic portosystemic stent-shunt

Core tip: Portal vein thrombosis is a complication of liver cirrhosis. Optimal management of portal vein thrombosis in cirrhosis has not been addressed in any consensus publication. There has been recent interest in the impact of portal vein thrombosis on the natural history of cirrhosis, and several authors have now described specific treatments for portal vein thrombosis, particularly with transjugular intrahepatic portosystemic stent-shunt and anticoagulation. We review current literature on portal vein thrombosis in cirrhosis and propose areas for future research to address unresolved clinical questions.