Anticoagulation in a cirrhotic patient with acute portal vein thrombosis unrelated to malignancy. A case report.

A 46-year old man, with the antecedent of lung abscesses in 2003, was diagnosed with alcoholic cirrhosis in 2006, when he developed ascites. In October 2008, he was admitted to hospital again with ascites (ASAG 1.74). Doppler ultrasound revealed extrahepatic and intrahepatic portal vein thrombosis, with patent splenic vein and no collateral vessels nor portal cavernomatosis. It showed also enlarged spleen and ascites. MR ruled out the presence of hepatic nodules suggesting hepatocellular carcinoma. Small esophageal varices were seen by upper endoscopy. With the suspicion of acute thrombosis, anticoagulant treatment with acenocumarol was given. Laboratory investigation for prothrombotic disorders showed deficit of protein C and antithrombin III, probably related to decreased synthesis secondary to liver disease. After six months of treatment, Doppler ultrasound showed that intraand extrahepatic portal vein was patent and spleen was smaller. Anticoagulation was discontinuated after one year of treatment, after assessing normalization of protein C and antithrombin III, as recommended by the haematologist. Doppler scan showed no signs of recurrence of thrombosis three months later.