Portal vein thrombosis

Last updated: September 12, 2022

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Portal vein thrombosis (PVT) refers to complete or partial closure of the portal vein due to a thrombus. Underlying causes include cirrhosis and malignancy. Acute PVT may present with abdominal pain and ascites, whereas chronic PVT is often asymptomatic. PVT is typically diagnosed with imaging demonstrating thrombus in the portal vein. Treatment depends on the acuity and whether there is underlying cirrhosis and typically consists of anticoagulation or thrombolysis; TIPS may be indicated in select cases.

Depend on the extent of thrombosis and the speed of manifestation

If PVT is detected in patients with cirrhosis, HCC must be ruled out as the cause. [2]

PVT can initially present with variceal bleed. Patients presenting with PVT should undergo screening for varices with upper GI endoscopy. [1]

Approach [2][3]

Management of PVT (e.g., anticoagulation) is determined on a case-by-case basis and specialists should be involved early.


For patients with cirrhosis, the choice of anticoagulant should be individualized and guided by a hematologist. Data on the safety of direct oral anticoagulants in cirrhosis is scarce. [2]

Surgical or interventional procedures [2]

  • Pharmacological thrombolysis (local or systemic): Consider in selected patients with persistent ischemia despite anticoagulation.
  • TIPS placement: can be considered in selected cases
  1. Ponziani FR. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment. World Journal of Gastroenterology. 2010; 16 (2): p.143. doi: 10.3748/wjg.v16.i2.143 . | Open in Read by QxMD
  2. Northup PG, Garcia‐Pagan JC, Garcia‐Tsao G, et al. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021; 73 (1): p.366-413. doi: 10.1002/hep.31646 . | Open in Read by QxMD
  3. Wu M, Schuster M, Tadros M. Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants. Journal of Clinical and Translational Hepatology. 2019; 7 (X): p.1-11. doi: 10.14218/jcth.2018.00057 . | Open in Read by QxMD

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