title: Portal vein thrombosis in cirrhosis: Controversies and latest developments.
abstract: Portal vein thrombosis (PVT) is encountered in liver cirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus publication. We review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation, and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%. PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions.
authors.affiliation: Damian J Harding, M Thamara PR Perera, Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Harding
authors.affiliation: Damian J Harding, M Thamara PR Perera, Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
authors.affiliation: Damian J Harding, M Thamara PR Perera, Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Frederick
authors.initials: F
authors.lastname: Chen
authors.affiliation: Damian J Harding, M Thamara PR Perera, Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Olliff
authors.affiliation: Damian J Harding, M Thamara PR Perera, Dhiraj Tripathi, Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Tripathi
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Liver cirrhosis; Portal vein thrombosis; Transjugular intrahepatic portosystemic stent-shunt