Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2018; 24(39): 4419-4427
Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4419
Portal vein thrombosis in cirrhotic patients - it is always the small pieces that make the big picture
Irina Gîrleanu, Anca Trifan, Carol Stanciu, Cătălin Sfarti
Irina Gîrleanu, Anca Trifan, Carol Stanciu, Cătălin Sfarti, Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, Iași 700115, Romania
Irina Gîrleanu, Anca Trifan, Carol Stanciu, Cătălin Sfarti, Institute of Gastroenterology and Hepatology, “St. Spiridon” University Hospital, Iași 700115, Romania
Author contributions: Gîrleanu I, Stanciu C, Sfarti C and Trifan A conceived and design the editorial; Gîrleanu I and Sfarti C wrote and revised the manuscript; Trifan A and Stanciu C critically revised the manuscript for important intellectual content and gave the final approval of the version to be published; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anca Trifan, MD, Doctor, Professor, Department of Gastroenterology, “Grigore T Popa” University of Medicine and Pharmacy, 16 Universitatii St, Iași 700115, Romania. ancatrifan@yahoo.com
Telephone: +40-72-6108428 Fax: +40-23-2211820
Received: July 27, 2018
Peer-review started: July 28, 2018
First decision: August 27, 2018
Revised: September 2, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018

Portal vein thrombosis (PVT) is a frequent and serious complication in patients with liver cirrhosis (LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease (compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex end-points such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.

Keywords: Portal vein thrombosis, Liver cirrhosis, Classification, Risk factors, Anticoagulation

Core tip: Portal vein thrombosis is a frequent and serious complication in patients with liver cirrhosis. The new classification needs to be validated and should contain the pattern of thrombus evolution and the status of liver cirrhosis- compensated or decompensated. The two main risk factors - reduced portal flow velocity and the hypercoagulable state should be addressed more extensively in large studies, considering the stage of liver disease. The anticoagulant treatment could be considered in cirrhotics with portal vein thrombosis. The end-points of the anticoagulant treatment should consider the recanalization, decompensation, and the mortality rates.