Portal Vein Thrombosis in Cirrhosis

J Clin Exp Hepatol. 2022 May-Jun;12(3):965-979. doi: 10.1016/j.jceh.2021.11.003. Epub 2021 Nov 22.


Patients with cirrhosis of the liver are at high risk of developing portal vein thrombosis (PVT), which has a complex, multifactorial cause. The condition may present with a myriad of symptoms and can occasionally cause severe complications. Contrast-enhanced computed tomography (CT) is the gold standard for the diagnosis of PVT. There are uncertainties regarding the effect on PVT and its treatment outcome in patients with cirrhosis. The main challenge for managing PVT in cirrhosis is analyzing the risk of hemorrhage compared to the risk of thrombus extension leading to complications. All current knowledge regarding non-tumor PVT in cirrhosis, including epidemiology, risk factors, classification, clinical presentation, diagnosis, impact on natural history, and treatment, is discussed in the present article.

Keywords: ACLF, acute-on-chronic liver failure; BCS, Budd–Chiari syndrome; DOACs, direct-acting oral anticoagulants; EASL, European Association for the Study of the Liver; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; INR, international normalized ratio; JAK2, Janus Kinase 2; LMWH, low molecular weight heparin; LT, liver transplant; MELD, Model for End-Stage Liver Disease; MTHFR, methyltetrahydrofolate reductase; NASH, non-alcoholic steatohepatitis; NO, nitric oxide; NSBBs, non-selective beta-blockers; PV, portal vein; PVT, Portal vein thrombosis; RCT, randomized controlled trial; SMA, superior mesenteric artery; SMV, superior mesenteric vein; SVT, splanchnic vein thrombosis; TIPS, Transjugular intrahepatic portosystemic shunt; UNOS, United Network for Organ Sharing; VEGF, vascular endothelial growth factors; VKAs, vitamin K antagonists; VKORC1, vitamin K epoxide reductase complex 1; anticoagulation; cirrhosis; eNOS, endothelial nitric oxide synthase; non-tumoral portal vein thrombosis; portal hypertension; rTPA, recombinant tissue plasminogen activator; transjugular intrahepatic portosystemic shunt; vWF, von Willebrand factor.

Publication types

  • Review