Portal Vein Thrombosis in Cirrhotic Patients: Decision to Anticoagulate

The portal vein is formed by the confluence of the splenic and superior mesenteric veins. Portal vein thrombosis (PVT) is caused by the formation of a blood clot within the extra-hepatic portion of the portal vein. Occlusion of the portal vein by thrombus typically occurs in patients with cirrhosis and/or prothrombotic disorders including hepatocellular carcinoma, myeloproliferative disorder, inherited thrombophilia and abdominal trauma [1]. Chronic portal vein thrombosis (PVT) may have a myriad of presentations including worsening clinical symptoms of portal hypertension i.e. ascites, gastroesophageal variceal bleeding or even completely asymptomatic, detected in routine abdominal imaging [1]. The management of portal vein thrombosis (PVT) includes differentiating acute from chronic, cirrhotic from non-cirrhotic causes, considering risk of variceal bleeding from anticoagulation, risk of bowel ischemia from clot extension and possibility of liver transplant [2].