Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis

Liver Int. 2012 Jul;32(6):919-27. doi: 10.1111/j.1478-3231.2012.02785.x. Epub 2012 Mar 21.


Background: There is no established management algorithm for portal vein thrombosis (PVT) in cirrhotic patients. The aim of our study was to prospectively evaluate anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS) to treat PVT.

Methods: Cirrhotics with non-malignant PVT were included. Low weight molecular heparin anticoagulation was considered in all; TIPS was indicated if thrombosis progressed or anticoagulation was contraindicated. Patients who were not anticoagulated nor received TIPS served as controls.

Results: Fifty-six patients (of whom 21 controls) were included. PVT was occlusive in 11/35, with extension to the superior mesenteric or splenic vein in 13/35. In the study group 33 patients were anticoagulated, with a recanalization rate of 36% (12/33) compared with 1/21 among controls. A time interval between appearance of thrombosis and anticoagulation < 6 months predicted chance of repermeation. Thrombus progression occurred in 15/21 non anticoagulated patients and in 5/33 anticoagulated patients (P < 0.001). TIPS was placed in six patients. There were five variceal bleedings and two intestinal venous ischaemia episodes in the control group, compared with one variceal bleeding episode in the study group.

Conclusions: In cirrhotics with PVT, a treatment algorithm using anticoagulation and TIPS achieves a good chance of complete repermeation, reduces portal hypertensive complications, and decreases the rate of thrombosis progression.

MeSH terms

  • Algorithms
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Blood Coagulation / drug effects*
  • Case-Control Studies
  • Chi-Square Distribution
  • Disease Progression
  • Female
  • Heparin, Low-Molecular-Weight / adverse effects
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Hypertension, Portal / blood
  • Hypertension, Portal / etiology
  • Hypertension, Portal / physiopathology
  • Hypertension, Portal / therapy*
  • Italy
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Portal Pressure
  • Portal Vein / physiopathology
  • Portal Vein / surgery*
  • Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Venous Thrombosis / blood
  • Venous Thrombosis / etiology
  • Venous Thrombosis / physiopathology
  • Venous Thrombosis / therapy*


  • Anticoagulants
  • Heparin, Low-Molecular-Weight