Open AccessPortal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate
Author(s) -
Mariella Faccia,
Maria Elena Ainora,
Francesca Romana Ponziani,
Laura Riccardi,
Matteo Garcovich,
Antonio Gasbarrini,
Maurizio Pompili,
Maria Assunta Zocco
Publication year - 2019
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v25.i31.4437
Subject(s) - medicine , portal vein thrombosis , cirrhosis , transjugular intrahepatic portosystemic shunt , natural history , portal hypertension , decompensation , thrombosis , asymptomatic , complication , liver disease , surgery
Portal vein thrombosis (PVT) represents a well-known complication during the natural course of liver cirrhosis (LC), ranging from asymptomatic cases to life-threating conditions related to portal hypertension and hepatic decompensation. Portal flow stasis, complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development. However, PVT occurrence remains unpredictable and many issues regarding its natural history, prognostic significance and treatment are still elusive. In particular although spontaneous resolution or disease stability occur in most cases of PVT, factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet. Moreover, PVT impact on LC outcome is still debated, as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression. Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases, even if the safer therapeutic option and the optimal therapy duration are still unknown. Nevertheless, their impact on mortality rates should be addressed more extensively. In this review we present the most debated questions regarding PVT, whose answers should come from prospective cohort studies and large sample-size randomized trials.