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Systematic review: portal vein thrombosis in cirrhosis

E A Tsochatzis1, M Senzolo, G Germani

  • 1The Royal Free Sheila Sherlock Liver Centre and Division of Surgery, Royal Free Hospital, Hampstead, London NW3 2QG, UK.

Alimentary Pharmacology & Therapeutics
|October 30, 2009
PubMed

Insights

Portal vein thrombosis (PVT) in cirrhosis is increasingly diagnosed. This review covers PVT in cirrhosis, highlighting its prevalence, pathophysiology, and management challenges, noting a lack of consensus for this condition.

Area of Science:

  • Hepatology
  • Vascular Medicine
  • Gastroenterology

Background:

  • Increasing detection of asymptomatic portal vein thrombosis (PVT) in cirrhosis patients via routine ultrasonography.
  • Absence of clinical consensus for PVT in cirrhosis, unlike noncirrhotic extra-hepatic PVT.
  • Cirrhosis is increasingly recognized for its thrombotic potential, challenging the traditional hypocoagulable state view.

Purpose of the Study:

  • To systematically review the prevalence, pathogenesis, diagnosis, clinical course, and management of nonmalignant portal vein thrombosis in cirrhosis.
  • To synthesize current knowledge and identify gaps in the understanding and treatment of PVT in cirrhosis.

Main Methods:

  • Systematic literature search conducted using MEDLINE and EMBASE databases.
  • Inclusion of studies focusing on nonmalignant portal vein thrombosis specifically in patients with cirrhosis.

Main Results:

  • Portal vein thrombosis (PVT) prevalence in cirrhosis ranges from 10% to 25%.
  • Pathophysiology indicates a thrombotic potential in cirrhosis, not solely a hypocoagulable state.
  • Clinical presentation varies from asymptomatic to life-threatening; management lacks consensus, with anticoagulation as a common first-line treatment.

Conclusions:

  • Significant unresolved issues exist regarding portal vein thrombosis in cirrhosis, posing clinical challenges.
  • Current management strategies for PVT in cirrhosis are not standardized, with anticoagulation being frequently used.
  • A research agenda is proposed to address critical knowledge gaps in PVT management for cirrhotic patients.
Abstract

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