Portal Vein Thrombosis and Cirrhosis: The Role of Anticoagulation

Anticoagulation has increasingly been reported as treatment of portal vein thrombosis (PVT) in cirrhosis. However, since the role of PVT in cirrhosis outcome is a debated issue, whether performing treatment of PVT in patients with cirrhosis remains a grey area. The aim of this review was to report an update on management of patients with PVT and cirrhosis.

A review on the management of PVT in cirrhosis, with emphasis on the role of anticoagulation was performed. Numerous studies reported different regimes of anticoagulation (AC) to determine a consistent rate of PV recanalization in cirrhosis. However, all together, data are scant in particular in regard to weight safety of treatment. Furthermore, there are no studies comparing anticoagulation with transjugular intrahepatic portosystemic shunt (TIPS), an alternative treatment for PVT in cirrhosis. Some papers suggest that PVT could worsen both hepatic decompensation and survival rates in patients with cirrhosis, while others report that PVT does not have a significant impact on the outcome of cirrhosis. Therefore, the prognostic value of PVT in cirrhosis remains uncertain. Furthermore, there is no evidence on whether both AC and TIPS really improve survival.

The indication of anticoagulation as a widespread therapy of PVT in cirrhosis is not acceptable, and decision about such treatment should be personalized. Future studies should evaluate which subgroup of patients with PVT and cirrhosis benefit treatment.