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Management of Non-tumoral Portal Vein Thrombosis in Patients with Cirrhosis

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Abstract

Non-tumoral portal vein thrombosis (PVT) remains a highly relevant topic in the field of hepatology and liver transplantation with much surrounding controversy. Although multiple studies have shown that PVT is associated with adverse outcomes with increased morbidity and mortality rates, others have not reported the same clinical impact of PVT, arguing rather that incident PVT reflects worsening portal hypertension and the natural history of the disease. Despite this uncertainly, PVT is a dilemma facing the clinician on a daily basis often requiring a multidisciplinary team-based approach between hepatologists, transplant surgeons, interventional radiologists and hematologists. In this review, the authors provide a summary of the evidence supporting best clinical practices in the management of non-tumoral PVT in patients with cirrhosis.

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Abbreviations

AC:

Anticoagulation

CTP:

Child–Turcotte–Pugh

DOAC:

Direct oral anticoagulant

INR:

International normalized ratio

LMWH:

Low molecular weight heparin

MELD:

Model for end-stage liver disease

PT:

Prothrombin time

PCC:

Prothrombin complex concentrates

PVT:

Portal vein thrombosis

SMV:

Superior mesenteric vein

TIPS:

Transjugular intrahepatic portosystemic shunt

VKA:

Vitamin K antagonist

VTE:

Venous thromboembolism

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA

    Jonathan G. Stine

  2. Department of Public Health Sciences, The Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA

    Jonathan G. Stine

  3. Department of Medicine, Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA

    Patrick G. Northup

Authors
  1. Jonathan G. Stine
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Correspondence to Jonathan G. Stine.

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Conflict of interest

Dr. Stine receives research support from TARGET Pharma, Inc. and serves as a consultant for Bayer, Inc. Dr. Northup has no financial conflict of interest.

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Stine, J.G., Northup, P.G. Management of Non-tumoral Portal Vein Thrombosis in Patients with Cirrhosis. Dig Dis Sci 64, 619–626 (2019). https://doi.org/10.1007/s10620-018-5427-3

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  • DOI: https://doi.org/10.1007/s10620-018-5427-3

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