Non-malignant Portal Vein Thrombosis in Liver Cirrhosis: Diagnosis and Treatment

Portal vein thrombosis (PVT) is considered a common complication of liver cirrhosis. Its prevalence increases with liver disease severity, reaching 25% in patients awaiting liver transplantation (LT). The majority of patients with cirrhosis are diagnosed incidentally with PVT during routine ultrasound in their cirrhosis follow-up. Doppler ultrasound is the recommended first-line investigation. Computed tomography or magnetic resonance angiography are the best methods to assess the extent of the PVT. The natural history of PVT in liver cirrhosis is not very well defined, but in the context of LT the deleterious effects of PVT are better known. There are no consensus guidelines about the treatment of PVT in cirrhotic patients and although anticoagulation is considered as the first-line therapy, the evidence regarding this treatment is based on a small series of patients. Nonetheless, it seems that anticoagulation therapy is useful in cirrhotic patients with PVT, particularly in patients who are candidates for a LT, in order to maximise the recanalisation rate and prevent thrombus progression. This treatment must be administered as soon as possible following a prophylactic treatment to avoid variceal bleeding, otherwise it seems to have a broad safety profile. A transjugular intrahepatic portosystemic shunt would be the alternative procedure for patients with no response to anticoagulation therapy or where portal hypertension complications occur.