SpringerLink
Log in

Portal Vein Thrombosis in Patients with Cirrhosis

  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Portal vein thromboses occur in patients with cirrhosis, including those awaiting liver transplant, and uncertainty exists regarding its prognosis, workup, and optimal management.

Recent Findings

The prevalence of PVT is higher in those with more severe liver disease (24% vs 14% for Child-Pugh B/C vs A, respectively). PVT, especially those with complete occlusion, is associated with mortality and graft loss in liver transplant recipients. Increasing data on direct oral anticoagulant (DOAC) use in cirrhosis and specifically for use in patients with PVT provides physicians and patients with more appealing anticoagulation options. In addition to observation and anticoagulation, there is an emerging role of transjugular intrahepatic porto-systemic (TIPS) shunt for recanalization of the portal vein in certain patients, with prospective single-center study demonstrating 98–100% efficacy in those with complete occlusion compared to a lower rate of patency with medical therapy alone (13%).

Summary

Due to the complexities involved in assessing and managing PVTs in cirrhosis based on individual patient factors, a multidisciplinary approach with hepatologists, hematologists, interventional radiologists, and transplant surgeons is strongly recommended for patients who are transplant candidates, have recurrent thromboses or complex anatomy, and may be considered in any patient with cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;73:366–413. https://doi.org/10.1002/hep.31646.

    Article  PubMed  Google Scholar 

  2. Yerdel MA, Gunson BK, Mirza DF, Mirza DF, Karayalcin K, Olliff S, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000; https://doi.org/10.1097/00007890-200005150-00023.

  3. Ageno W, Dentali F, Squizzato A. How I treat splanchnic vein thrombosis. Blood. 2014;124:3685–91. https://doi.org/10.1182/blood-2014-07-551515.

    Article  CAS  PubMed  Google Scholar 

  4. Luo F, Li M, Ding J, Zheng S. The progress in the treatment of hepatocellular carcinoma with portal vein tumor thrombus. Front Oncol. 2021;11 https://doi.org/10.3389/fonc.2021.635731.

  5. Balfour GW, Stewart TG. Case of enlarged spleen complicated with ascites, both depending upon varicose dilatation and thrombosis of the portal vein. Edinb Med J. 1869;14:589–98.

    PubMed  PubMed Central  Google Scholar 

  6. Violi F, Basili S, Raparelli V, Chowdary P, Gatt A, Burroughs AK. Patients with liver cirrhosis suffer from primary haemostatic defects? Fact or fiction? J Hepatol. 2011;55:1415–27. https://doi.org/10.1016/j.jhep.2011.06.008.

    Article  CAS  PubMed  Google Scholar 

  7. Stine JG, Wang J, Shah PM, Argo CK, Intagliata NM, Uflacker A, et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int. 2018; https://doi.org/10.1111/liv.13500.

  8. Lisman T, Luyendyk JP, Caldwell SH, Intagliata NM. Haemostatic alterations and management of haemostasis in patients with cirrhosis. J Hepatol. 2022; https://doi.org/10.1016/j.jhep.2021.11.004.

  9. Lisman T, Bongers TN, Adelmeijer J, Janssen HLA, de Maat MPM, de Groot PG, et al. Elevated levels of von Willebrand factor in cirrhosis support platelet adhesion despite reduced functional capacity. Hepatol Baltim Md. 2006;44:53–61. https://doi.org/10.1002/hep.21231.

    Article  CAS  Google Scholar 

  10. Saugel B, Saugel B, Lee M, Lee M, Lee M, Feichtinger S, et al. Thrombophilic factor analysis in cirrhotic patients with portal vein thrombosis. J Thromb Thrombolysis. 2015; https://doi.org/10.1007/s11239-014-1124-z.

  11. Ma SD, Wang J, Bezinover D, Kadry Z, Northup PG, Stine JG. Inherited thrombophilia and portal vein thrombosis in cirrhosis: a systematic review and meta-analysis. Res Pract Thromb Haemost. 2019;3:658–67. https://doi.org/10.1002/rth2.12253.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Turon F, Driever EG, Baiges A, Cerda E, García-Criado Á, Gilabert R, et al. Predicting portal thrombosis in cirrhosis: a prospective study of clinical, ultrasonographic and hemostatic factors. J Hepatol. 2021;75:1367–76. https://doi.org/10.1016/j.jhep.2021.07.020.

    Article  PubMed  Google Scholar 

  13. Fortea JI, Carrera IG, Puente Á, Cuadrado A, Huelin P, Tato CÁ, et al. Portal thrombosis in cirrhosis: role of thrombophilic disorders. J Clin Med. 2020;9:2822. https://doi.org/10.3390/jcm9092822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Violi F, Corazza GR, Caldwell SH, Talerico G, Romiti GF, Napoleone L, et al. Incidence and recurrence of portal vein thrombosis in cirrhotic patients. Thromb Haemost. 2019; https://doi.org/10.1055/s-0038-1676981.

  15. Wosiewicz P, Żorniak M, Hartleb M, Barański K, Chrabańska M, Hartleb M, et al. Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability. Clin Res Hepatol Gastroenterol. 2016; https://doi.org/10.1016/j.clinre.2016.03.008.

  16. Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou P-E, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology. 2015;61:660. https://doi.org/10.1002/hep.27546.

    Article  CAS  PubMed  Google Scholar 

  17. Violi F, Corazza RG, Caldwell SH, Perticone F, Gatta A, Angelico M, et al. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry. Intern Emerg Med. 2016;11:1059–66. https://doi.org/10.1007/s11739-016-1416-8.

    Article  PubMed  Google Scholar 

  18. Pan J, Wang L, Gao F, An Y, Yin Y, Guo X, et al. Epidemiology of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Eur J Intern Med. 2022;104:21–32. https://doi.org/10.1016/j.ejim.2022.05.032.

    Article  PubMed  Google Scholar 

  19. Yeo JW, Law MSN, Lim JCL, Ng CH, Tan DJH, Tay PWL, et al. Meta-analysis and systematic review: prevalence, graft failure, mortality, and post-operative thrombosis in liver transplant recipients with pre-operative portal vein thrombosis. Clin Transplant. 2022;36:e14520. https://doi.org/10.1111/ctr.14520.

    Article  PubMed  Google Scholar 

  20. Zanetto A, Rodriguez-Kastro K-I, Germani G, Ferrarese A, Cillo U, Burra P, et al. Mortality in liver transplant recipients with portal vein thrombosis – an updated meta-analysis. Transpl Int. 2018;31:1318–29. https://doi.org/10.1111/tri.13353.

    Article  PubMed  Google Scholar 

  21. Senzolo M M, Sartori T, Rossetto V, Burra P, Cillo U, Boccagni P, et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosistemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int. 2012;32:919–27. https://doi.org/10.1111/j.1478-3231.2012.02785.x.

    Article  CAS  PubMed  Google Scholar 

  22. Luca A, Caruso S, Milazzo M, Marrone G, Mamone G, Crinò F, et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology. 2012;265:124–32. https://doi.org/10.1148/radiol.12112236.

    Article  PubMed  Google Scholar 

  23. Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and meta-analysis. Gastroenterology. 2017; https://doi.org/10.1053/j.gastro.2017.04.042.

  24. Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Off J Am Coll Gastroenterol ACG. 2013;108:568. https://doi.org/10.1038/ajg.2012.452.

    Article  Google Scholar 

  25. Noronha Ferreira C, Marinho RT, CortezPinto H, Ferreira P, Dias MS, Vasconcelos M, et al. Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: a prospective study. Liver Int. 2019;39:1459–67. https://doi.org/10.1111/liv.14121.

    Article  PubMed  Google Scholar 

  26. Englesbe MJ, Schaubel DE, Cai S, Guidinger MK, Merion RM. Portal vein thrombosis and liver transplant survival benefit. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2010;16:999–1005. https://doi.org/10.1002/lt.22105.

    Article  Google Scholar 

  27. Ghabril M, Agarwal S, Lacerda MA, Lacerda MA, Chalasani N, Kwo PY, et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation. 2016; https://doi.org/10.1097/tp.0000000000000785.

  28. Rhu J, Choi G-S, Kwon CHD, Kim JM, Joh J-W. Portal vein thrombosis during liver transplantation: the risk of extra-anatomical portal vein reconstruction. J Hepato-Biliary-Pancreat Sci. 2020;27:242–53. https://doi.org/10.1002/jhbp.711.

    Article  Google Scholar 

  29. Turon F, Hernández-Gea V, García-Pagán JC. Portal vein thrombosis: yes or no on anticoagulation therapy. Curr Opin Organ Transplant. 2018; https://doi.org/10.1097/mot.0000000000000506.

  30. Zocco MA, Stasio ED, Cristofaro RD, Novi M, Ainora ME, Ainora ME, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol. 2009; https://doi.org/10.1016/j.jhep.2009.03.013.

  31. Basili S, Carnevale R, Nocella C, Bartimoccia S, Raparelli V, Talerico G, et al. Serum albumin is inversely associated with portal vein thrombosis in cirrhosis. Hepatol Commun. 2019;3:504–12. https://doi.org/10.1002/hep4.1317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Swan D, Lisman T, Tripodi A, Thachil J. The prothrombotic tendency of metabolic-associated fatty liver disease. J Thromb Haemost. 2023; https://doi.org/10.1016/j.jtha.2023.06.017.

  33. Stine JG, Shah NL, Argo CK, Pelletier SJ, Caldwell SH, Northup PG, et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transpl. 2015; https://doi.org/10.1002/lt.24134.

  34. Bezinover D, Iskandarani K, Chinchilli V, McQuillan P, Saner F, Kadry Z, et al. Autoimmune conditions are associated with perioperative thrombotic complications in liver transplant recipients: a UNOS database analysis. BMC Anesthesiol. 2015;16:1–7. https://doi.org/10.1186/s12871-016-0192-3.

    Article  CAS  Google Scholar 

  35. Ak Ç. Portal vein thrombosis risk factors in liver transplant candidates. Hepatol Forum. 2022; https://doi.org/10.14744/hf.2022.2022.0005.

  36. Stine JG, Argo CK, Pelletier SJ, Maluf DG, Caldwell SH, Northup PG. Advanced non-alcoholic steatohepatitis cirrhosis: a high-risk population for pre-liver transplant portal vein thrombosis. World J Hepatol. 2017;9:139–46. https://doi.org/10.4254/wjh.v9.i3.139.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Gaballa D, Bezinover D, Kadry Z, Eyster E, Wang M, Northup PG, et al. Development of a model to predict portal vein thrombosis in liver transplant candidates: the portal vein thrombosis risk index. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2019;25:1747–55. https://doi.org/10.1002/lt.25630.

    Article  Google Scholar 

  38. Garg P, Harrison B, Gane EJ. Incident portal vein thrombosis in liver transplant recipients in New Zealand: predictors of risk and validation of portal vein thrombosis risk index calculator. Front Transplant. 2022:1. https://doi.org/10.3389/frtra.2022.1042684.

  39. Amitrano L, Guardascione MA, Brancaccio V, Margaglione M, Manguso F, Iannaccone L, et al. Risk factors and clinical presentation of portal vein thrombosis in patients with liver cirrhosis. J Hepatol. 2004;40:736–41. https://doi.org/10.1016/j.jhep.2004.01.001.

    Article  PubMed  Google Scholar 

  40. Bach AM, Hann LE, Brown KT, Getrajdman GI, Herman SK, Fong Y, et al. Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology. 1996; https://doi.org/10.1148/radiology.201.1.8816536.

  41. Margini C, Berzigotti A. Portal vein thrombosis: the role of imaging in the clinical setting. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2017;49:113–20. https://doi.org/10.1016/j.dld.2016.11.013.

    Article  Google Scholar 

  42. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty BVII, Baveno VII. Renewing consensus in portal hypertension. J Hepatol. 2022;76:959–74. https://doi.org/10.1016/j.jhep.2021.12.022.

    Article  PubMed  Google Scholar 

  43. Senzolo M, Garcia-Tsao G, García-Pagán JC. Current knowledge and management of portal vein thrombosis in cirrhosis. J Hepatol. 2021;75:442–53. https://doi.org/10.1016/j.jhep.2021.04.029.

    Article  PubMed  Google Scholar 

  44. Jamieson NV. Changing perspectives in portal vein thrombosis and liver transplantation. Transplantation. 2000:69. https://doi.org/10.1097/00007890-200005150-00006.

  45. Charco R, Fuster J, Fondevila C, Ferrer J, Mans E, Garcı́a-Valdecasas JC. Portal vein thrombosis in liver transplantation. Transplant Proc. 2005;37:3904–5. https://doi.org/10.1016/j.transproceed.2005.09.120.

    Article  CAS  PubMed  Google Scholar 

  46. Sarin SK, Philips CA, Kamath PS, Choudhury A, Maruyama H, Maruyama H, et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology. 2016; https://doi.org/10.1053/j.gastro.2016.08.033.

  47. Ma J, Yan Z, Luo J, Liu Q, Wang J, Qiu S. Rational classification of portal vein thrombosis and its clinical significance. PLOS ONE. 2014;9:e112501. https://doi.org/10.1371/journal.pone.0112501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. De Gaetano AM, Lafortune M, Patriquin H, De Franco A, Aubin B, Paradis K. Cavernous transformation of the portal vein: patterns of intrahepatic and splanchnic collateral circulation detected with Doppler sonography. Am J Roentgenol. 1995;165:1151–5. https://doi.org/10.2214/ajr.165.5.7572494.

    Article  Google Scholar 

  49. Fisher NC, Wilde JT, Roper J, Elias E. Deficiency of natural anticoagulant proteins C, S, and antithrombin in portal vein thrombosis: a secondary phenomenon? Gut. 2000;46:534–9. https://doi.org/10.1136/gut.46.4.534.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Villa E, Cammà C, Marietta M, Luongo M, Critelli R, Colopi S, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143:1253–1260.e4. https://doi.org/10.1053/j.gastro.2012.07.018.

    Article  CAS  PubMed  Google Scholar 

  51. Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol. 2020;115:18–40. https://doi.org/10.14309/ajg.0000000000000486.

    Article  PubMed  Google Scholar 

  52. Berry K, Taylor J, Liou IW, Ioannou GN. Portal vein thrombosis is not associated with increased mortality among patients with cirrhosis. Clin Gastroenterol Hepatol. 2015;13:585–93. https://doi.org/10.1016/j.cgh.2014.10.010.

    Article  PubMed  Google Scholar 

  53. Legnani C, Martinelli I, Palareti G, Ciavarella A, Poli D, Ageno W, et al. D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-vitamin K anticoagulants. PloS One. 2019;14:e0219751. https://doi.org/10.1371/journal.pone.0219751.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Elkrief L, Payancé A, Plessier A, d’Alteroche L, Ronot M, Paradis V, et al. Management of splanchnic vein thrombosis. JHEP Rep. 2023:5. https://doi.org/10.1016/j.jhepr.2022.100667.

  55. Maruyama H, Takahashi M, Shimada T, Yokosuka O. Emergency anticoagulation treatment for cirrhosis patients with portal vein thrombosis and acute variceal bleeding. Scand J Gastroenterol. 2012;47:686–91. https://doi.org/10.3109/00365521.2012.674972.

    Article  CAS  PubMed  Google Scholar 

  56. Artaza T, Lopes M, Romero M, Gómez A-Z, de la Cruz G, Sánchez JJ, et al. Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis. Gastroenterol Hepatol. 2018;41:611–7. https://doi.org/10.1016/j.gastrohep.2018.06.005.

    Article  PubMed  Google Scholar 

  57. Francoz C, Belghiti J, Vilgrain V, Vilgrain V, Sommacale D, Sommacale D, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005; https://doi.org/10.1136/gut.2004.042796.

  58. Chen H, Liu L, Qi X, He C, Wu F, Fan D, et al. Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2016; https://doi.org/10.1097/meg.0000000000000482.

  59. Amitrano L, Guardascione MA, Menchise A, Martino R, Scaglione M, Giovine S, et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. Dig Liver Dis. 2009; https://doi.org/10.1016/j.dld.2008.12.047.

  60. Delgado MG, Seijo S, Yepes I, Achécar L, Achecar L, Achécar L, et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2012; https://doi.org/10.1016/j.cgh.2012.01.012.

  61. Chung JW, Kim GH, Lee JH, Ok KS, Jang ES, Jeong S-H, et al. Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis. Clin Mol Hepatol. 2014;20:384–91. https://doi.org/10.3350/cmh.2014.20.4.384.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Pettinari I, Vukotic R, Stefanescu H, Pecorelli A, Morelli M, Grigoras C, et al. Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol. 2019; https://doi.org/10.1038/s41395-018-0421-0.

  63. Bergère M, Erard-Poinsot D, Boillot O, Valette P-J, Guillaud O, Chambon-Augoyard C, et al. Portal vein thrombosis and liver cirrhosis: long-term anticoagulation is effective and safe. Clin Res Hepatol Gastroenterol. 2019;43:395–402. https://doi.org/10.1016/j.clinre.2018.11.011.

    Article  PubMed  Google Scholar 

  64. La Mura V, Braham S, Tosetti G, Branchi F, Bitto N, Moia M, et al. Harmful and beneficial effects of anticoagulants in patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol. 2018;16:1146–1152.e4. https://doi.org/10.1016/j.cgh.2017.10.016.

    Article  CAS  PubMed  Google Scholar 

  65. Qi X, Stefano VD, Li H, Dai J, Guo X, Fan D. Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015; https://doi.org/10.1016/j.ejim.2014.12.002.

  66. Guerrero A, del Campo L, Piscaglia F, Scheiner B, Han G, Violi F, et al. Anticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: the IMPORTAL competing-risk meta-analysis. J Hepatol. 2023;79:69–78. https://doi.org/10.1016/j.jhep.2023.02.023. High-quality individual patient data meta-analysis reporting on the outcomes of anticoagulation on patients with cirrhosis and portal vein thrombosis. They report a survival benefit with anticoagulation independent of thrombosis severity and recanalization.

    Article  CAS  PubMed  Google Scholar 

  67. Ai M, Dong W, Tan X, Xu L, Xu C, Zhang Q, et al. Efficacy and safety study of direct-acting oral anticoagulants for the treatment of chronic portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2020;32:1395. https://doi.org/10.1097/MEG.0000000000001846. Prospective cohort study on the treatment of chronic portal vein thrombosis in patients with cirrhosis with direct oral anticoagulants.

    Article  CAS  PubMed  Google Scholar 

  68. Di Nisio M, Valeriani E, Riva N, Schulman S, Beyer-Westendorf J, Ageno W. Anticoagulant therapy for splanchnic vein thrombosis: ISTH SSC Subcommittee Control of Anticoagulation. J Thromb Haemost JTH. 2020;18:1562–8. https://doi.org/10.1111/jth.14836.

    Article  PubMed  Google Scholar 

  69. Villa E, Bianchini M, Blasi A, Denys A, Giannini EG, de Gottardi A, et al. EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol. 2022;76:1151–84. https://doi.org/10.1016/j.jhep.2021.09.003.

    Article  Google Scholar 

  70. Weinberg EM, Palecki J, Reddy KR. Direct-acting oral anticoagulants (DOACs) in cirrhosis and cirrhosis-associated portal vein thrombosis. Semin Liver Dis. 2019; https://doi.org/10.1055/s-0039-1679934.

  71. Koh JH, Liew ZH, Ng GK, Liu HT, Tam YC, De Gottardi A, et al. Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: a systematic review and meta-analysis. Dig Liver Dis. 2022;54:56–62. https://doi.org/10.1016/j.dld.2021.07.039. High-quality meta-analysis comparing direct oral anticoagulants and vitamin K antagonists for the treatment of portal vein thrombosis in patients with cirrhosis.

    Article  CAS  PubMed  Google Scholar 

  72. Madoff DC, Gaba RC, Weber CN, Clark TWI, Saad WE. Portal venous interventions: state of the art. Radiology. 2016;278:333–53. https://doi.org/10.1148/radiol.2015141858.

    Article  PubMed  Google Scholar 

  73. Shalvoy MR, Ahmed M, Weinstein JL, Ramalingam V, Malik MS, Ali A, et al. Transjugular intrahepatic portosystemic shunt and thrombectomy (TIPS-thrombectomy) for symptomatic acute noncirrhotic portal vein thrombosis. J Vasc Interv Radiol JVIR. 2023;34:1373–1381.e3. https://doi.org/10.1016/j.jvir.2023.05.009.

    Article  PubMed  Google Scholar 

  74. Thornburg B, Desai KR, Hickey R, Hohlastos E, Kulik L, Ganger D, et al. Pretransplantation portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: final analysis of a 61-patient cohort. J Vasc Interv Radiol. 2017; https://doi.org/10.1016/j.jvir.2017.08.005.

  75. Rodrigues SG, Sixt S, Abraldes JG, De Gottardi A, Klinger C, Bosch J, et al. Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther. 2019;49:20–30. https://doi.org/10.1111/apt.15044. Prospective cohort study comparing transjugular intrahepatic portosystemic shunt to anticoagulation for patients with cirrhosis and portal vein thrombosis.

    Article  PubMed  Google Scholar 

  76. Wu W, Zhang H, Zeng Z, Wang X, Kong D. Comparison of transjugular intrahepatic portosystemic with endoscopic treatment plus anticoagulation for esophageal variceal bleeding and portal vein thrombosis in liver cirrhosis. Scand J Gastroenterol. 2022;57:1494–502. https://doi.org/10.1080/00365521.2022.2094724. Retrospective cohort study reporting the performance characteristic of the Model for End-Stage Liver Disease (MELD) 3.0 score for predicting mortality in those undergoing transjugular intrahepatic portosystemic shunt.

    Article  CAS  PubMed  Google Scholar 

  77. Lv Y, Bai W, Li K, Wang Z, Guo W, Luo B, et al. Anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis: a prospective observational study. Am J Gastroenterol. 2021;116(7):1447–1464. Review article of interventional approaches to portal vein thrombosis in patients with cirrhosis and potential liver transplant candidates.

  78. Song J, Wang X, Yan Y, **ang T, Luo X. MELD 3.0 score for predicting survival in patients with cirrhosis after transjugular intrahepatic portosystemic shunt creation. Dig Dis Sci. 2023;68:3185–92. https://doi.org/10.1007/s10620-023-07834-3.

    Article  PubMed  Google Scholar 

  79. Ramalingam V, Yang LM, McCarthy CJ, Ahmed M. Interventional approach to portal vein thrombosis and liver transplantation: state of the art. Life. 2023;13:1262. https://doi.org/10.3390/life13061262.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Boike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, et al. North American practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension. Clin Gastroenterol Hepatol. 2022;20:1636–1662.e36. https://doi.org/10.1016/j.cgh.2021.07.018.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. BIDMC - Division of Gastroenterology/Liver Center, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 8E, Boston, MA, 02215-5400, USA

    Peter L. Wang & Lauren M. Yang

  2. Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

    Vijay Ramalingam

Authors
  1. Peter L. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vijay Ramalingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lauren M. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PW and LY wrote the majority of manuscript text. VR contributed to interventional radiology treatment section text. All authors reviewed the manuscript.

Corresponding author

Correspondence to Lauren M. Yang.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, P.L., Ramalingam, V. & Yang, L.M. Portal Vein Thrombosis in Patients with Cirrhosis. Curr Hepatology Rep 23, 64–72 (2024). https://doi.org/10.1007/s11901-024-00636-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-024-00636-9

Keywords

Search

Navigation