REVIEW  DIFFICULT CHALLENGES IN VASCULAR MEDICINE 

Minerva Medica 2021 December;112(6):713-25

DOI: 10.23736/S0026-4806.21.07526-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Treatment of portal vein thrombosis: an updated narrative review

Lucia M. CAIANO ^{1, 2}, Nicoletta RIVA ³ ✉, Marc CARRIER ², Alex GATT ³, Walter AGENO ¹

¹ Department of Medicine and Surgery, University of Insubria, Varese, Italy; ² Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; ³ Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta

Portal vein thrombosis (PVT) is the most frequent among the splanchnic vein thrombosis, accounting for 90% of cases. More than half of PVT are provoked by liver cirrhosis, solid cancer or myeloproliferative neoplasms. The remaining cases are non-malignant non-cirrhotic PVT and include either unprovoked events or thrombosis secondary to other less common risk factors (e.g. abdominal surgery, intrabdominal inflammations/infections, or hormonal stimuli). Anticoagulant therapy in patients with acute symptomatic PVT should be started early after diagnosis, if no active bleeding, to obtain greater vessel recanalization and reduce the occurrence of portal-hypertension related complications. Gastroesophageal varices do not represent a contraindication to anticoagulant treatment, as long as adequate measures have been undertaken for the prophylaxis of gastroesophageal bleeding. Different treatment options (unfractionated or low molecular weight heparin, vitamin K antagonists and direct oral anticoagulants [DOACs]) can be considered. In this narrative review we will discuss the treatment of PVT in the three most common scenarios (cirrhosis-associated, cancer-associated and non-malignant non-cirrhotic PVT). We will also discuss the role of the DOACs and summarize recent guidelines on this topic.

KEY WORDS: Portal vein; Thrombosis; Liver cirrhosis; Neoplasms; Anticoagulants; Therapy