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Semin Thromb Hemost 2020; 46(06): 673-681
DOI: 10.1055/s-0040-1715473
Review Article

New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

Oana Nicoară-Farcău
1   Department of Hepatology, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor,” “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
,
Guillem Soy
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
,
Marta Magaz
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
,
Anna Baiges
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
,
Fanny Turon
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
,
Angeles Garcia-Criado
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
5   Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
,
Marta Barrufet
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
5   Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
,
Marta Burrel
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
5   Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
,
Virginia Hernández-Gea
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
,
Juan Carlos García-Pagán
2   Liver Unit, Barcelona Hepatic Hemodynamic Laboratory, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
3   Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
4   Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver)
› Author Affiliations Funding J.C.G.P. received support in part through grants from the Spanish Ministry of Education and Science (SAF-2016–75767-R), Fondo Europeo de Desarrollo Regional (FEDER) (PIE15/00027), “Commissioner for Universities and Research of the Generalitat de Catalunya” (AGAUR SGR 2017), and The Spanish Health Ministry (National Strategic Plan against Hepatitis C) Secretariat for Universities and Research of the Department of Economy and Knowledge (SGR17_00517). V.H-G. received support from the Spanish Ministry of Education and Science (PI17/00398) and the Spanish Health Ministry (National Strategic Plan against Hepatitis C). A.B and M.M. are recipients of a “Río Hortega” fellowship grant from the Instituto de Salud Carlos III.
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Abstract

Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis regardless of etiology. Notwithstanding the commonality of the problem, the pathophysiology and risk factors for PVT in cirrhosis are largely unknown. The clinical impact of PVT in the natural history of cirrhosis is unclear, indications for PVT treatment are not well defined, and treatment recommendations are based on experts' opinion and consensus only. Therefore, this review aims to summarize current knowledge of mechanisms and risk factors for PVT development and assess the current evidence of PVT management, with a special focus on strategies of anticoagulation and transjugular intrahepatic portosystemic shunt placement.

Keywords

portal vein thrombosis - anticoagulation - cirrhosis - TIPS placement


Publication History

Article published online:
20 August 2020

© 2020. Thieme. All rights reserved.

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