Portal vein
thrombosis in
cirrhosis is a relatively common complication associated with the presence of an accompanying prothrombotic phenotype of advanced
cirrhosis. The consequences of portal vein
thrombosis are relevant because it can be associated with impaired hepatic function, might contraindicate
hepatic transplantation and could increase morbidity in the
surgical procedure. There is controversy concerning the most effective treatment of portal vein
thrombosis, which is based on information that is seldom robust and whose primary objective is to achieve a return to vessel patency. Various studies have suggested that starting anticoagulation
therapy early is associated with portal vein repatency more frequently than without treatment and has a low rate of complications. There are no proven data on the type of
anticoagulant (low-molecular-weight heparins or
dicoumarin agents) and the
treatment duration. The implementation of
TIPS is technically feasible in
thrombosis without cavernous transformation and is associated with portal vein recanalization in a significant proportion of cases.
Thrombolytic therapy does not appear to present an adequate balance between efficacy and safety; its use is therefore not supported for this indication. The proper definition of treatment for portal vein
thrombosis requires properly designed studies to delimit the efficacy and safety of the various alternatives.