Portal vein thrombosis in a patient on semaglutide

Background: Obesity and type 2 diabetes mellitus (T2DM) are both modern-day pandemics, significantly impacting worldwide healthcare. The glucagon-like peptide-1 receptor agonist (GLP1-RA) semaglutide is a novel treatment for both T2DM and obesity; however, it can be associated with an increased risk of venous thromboembolism (VTE). Case presentation: This case report describes a 59-year-old woman with T2DM who received semaglutide for the management of glycemic levels and also experienced the additional advantage of weight reduction. Within 6 months of initiating GLP1-RA, the patient presented with lower back pain associated with nausea and poor oral intake. She had no known risk factors for VTE or thrombophilia or any history of significant illness in her family. Her physical examination revealed no significant findings; only mild leukocytosis and neutrophilia were detected. She underwent an abdominal computed tomography scan, which revealed intrahepatic portal vein thrombosis without evidence of liver cirrhosis or abdominal malignancy. Her symptoms improved with oral anticoagulation (rivaroxaban). The result of the thrombophilia examination was negative for inherited or acquired thrombophilia, with the exception of mutation of Janus kinase 2, which may increase the risk of thrombosis. Conclusions: The use of GLP1-RA is increasing due to the growing desire for weight loss medications; therefore, it is pertinent for physicians to have a better understanding of the possible risks for thrombosis before initiating GLP1-RA treatment.