Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 11 / 16 / 2019

Articles

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

REVIEW ARTICLE

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Matthew Wu1, Michael Schuster2 and Micheal Tadros*,3

1Albany Medical College, Albany, NY, USA
2Department of Radiology, Albany Medical Center Hospital, Albany, NY, USA
3Department of Gastroenterology, Albany Medical Center Hospital, Albany, NY, USA
*Correspondence to: Micheal Tadros, Department of Gastroenterology, Albany Medical Center Hospital, 1769 Union St. 2nd Floor Niskayuna Medical Arts Building Schenectady, Albany, NY 12308, USA. Tel: +1-551-655-5171, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):154-164 DOI: 10.14218/JCTH.2018.00057
Received: October 20, 2018 Accepted: May 29, 2019 Published online: June 28, 2019

Abstract

The clinical management of portal vein thrombosis (PVT) remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. The natural history and clinical outcome of PVT are highly variable, dependent upon size, extent and degree of the thrombotic occlusion, as well as the physiological impact of patient comorbidities. While existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT, management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis, factoring in the state of underlying liver disease. In general, patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer management. However, existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying cancer. While low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT, an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in PVT. As such, direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.

Keywords

Portal vein, Thrombosis, Liver cirrhosis, Neoplasm, Anticoagulant

 

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 154-164  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

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