Portal vein thrombosis in cirrhotic and non cirrhotic patients : from diagnosis to treatment

Introduction: Portal vein thrombosis (PVT) may occur in non-cirrhotic and cirrhotic patients. It can be classified as acute (if a recent thrombus is present) and chronic (if portal cavernoma has developed). Patients can be symptomatic or may present signs and symptoms related to the development of portal hypertension. In rare cases bowel infarction may occur. Areas covered: This review provides an overview of the clinical presentation, complications, diagnostic challenges and available treatments for PVT in non-cirrhotic and cirrhotic patients (NCPVT). Expert opinion: Treatment of acute NCPVT aims at recanalizing the thrombosed veins and preventing intestinal infarction and portal hypertension. Anticoagulation should be started promptly and maintained for at least 6 months. Long-term anticoagulation should be implemented in the presence of underlying persistent thrombotic state. In chronic NCPVT, treatment aims at managing portal hypertension and portal cavernoma cholangiopathy and preventing new thrombotic events. In this setting, the indication for anticoagulation should be individualized. No formal recommendations can be given for PVT in cirrhosis, since there are no randomized controlled trials, prospective studies, or ad hoc guidelines. High quality studies, including randomized controlled trials, will be needed to provide robust evidence on the best treatment strategy.