Portal vein thrombosis associated with cirrhosis: clinical importance

A group of 86 cirrhotics undergoing therapeutic variceal decompressive procedures were studied. Patients with portal vein thrombosis (PVT) comprised 21% of the group and more frequently had uncontrollable hemorrhage at an earlier stage of liver disease. Mortality in the 18 cirrhotics with PVT was higher (56%), mostly as a result of rebleeding. Despite adjustments for stage of liver disease and type of operation, in no cirrhotic with PVT did postshunt encephalopathy develop, compared with 32% incidence in patients without PVT (P less than .05). It is concluded that patients with cirrhosis and PVT represent a different subpopulation of cirrhotics. Once adequate variceal decompression has been achieved, their prognosis should be superior to cirrhotics without PVT because their hepatic hemodynamics are unaffected by total shunting, hence precluding further impairment of liver function as a result of acute reduction of hepatic blood flow.