Optimal Management of Portal Vein Thrombosis in Patients with Liver Cirrhosis: a Review

Portal vein thrombosis (PVT) is a fairly common complication of cirrhosis, especially in patients with advanced liver disease and reduced portal vein flow velocity. Prospective studies have shown that its occurrence parallels rather than causes the progression of liver disease and that spontaneous regression is a frequent finding. PVT occurrence is associated with an increased mortality after liver transplantation. Treatment options include anticoagulation and insertion of a transjugular intrahepatic portosystemic shunt. Anticoagulation with vitamin K antagonists or low-molecular-weight heparins achieves partial or complete portal vein recanalization in most patients. Anticoagulation does not seem to increase the bleeding risk when proper prophylaxis of variceal bleeding is applied. Monitoring of anticoagulation difficulties exist, inherent to the coagulopathy of chronic liver disease. Placement of a transjugular intrahepatic portosystemic shunt is an alternative in selected patients. Trials are underway to evaluate the potential benefit of PVT prophylaxis with low-molecular-weight heparins.