Portal Vein Thrombosis

Top tips:

  1. Available data on this topic is predominantly non-randomized and observational. Guidance statements are consistent with a recent expert consensus based guidelines including PMID 31895720. Consult specialist on-call for most of these cases.
  2. Doppler ultrasound is the first-line evaluation for the diagnosis of portal vein thrombosis (PVT). Perform an Ultrasound doppler to evaluate for PVT in all patients with (i) a new diagnosis of cirrhosis, (ii) onset of portal hypertension, (iii) hepatic decompensation.
  3. CT or MRI should be used to confirm the diagnosis, to exclude tumor thrombus and assess extension into the mesenteric veins
  4. In patients with chronic PVT who meet indication for anticoagulation, assess for high-risk varices with endoscopy. If high risk varices are present, non-selective beta-blockers are suggested for the primary prevention of variceal bleeding.
  5. After considering the individual risks and benefits, anticoagulation is recommended for certain patients with PVT (see algorithm).
  6. HCC related tumor thrombus does not benefit from anticoagulation
  7. Continue anticoagulation for 6 months and potentially longer in certain patients.

General Cirrhosis Admission and Discharge Order Sets

*Add specific panels to general admission orders as appropriate*

For adults with cirrhosis requiring hospital admission
Cirrhosis Adult Admission Orders

For adults with cirrhosis requiring hospital discharge
Cirrhosis Adult Discharge Orders

Check out the bottom of the page for short videos from Dr. Garcia-Tsao!

Portal Vein Thrombosis in the Setting of Cirrhosis

Introducing Dr. Garcia-Tsao

Video 1 – The top tips that may be useful for you to know about this page as a family physician including: How commonly does PVT occur? ; When do I need to call a specialist?

Coming soon!

Video 2 – Practical tips for diagnosing and managing PVT in patients with cirrhosis – how I do it.

Coming soon!

Patient materials:

You can direct patients to the following:
Portal hypertension

Downloadable content:

You can download these to print or view offline:
EASL Guidelines for decompensated cirrhosis

References:

This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.

Authors:  Dr. Vladimir Marquez, Dr. Guadalupe Garcia-Tsao, Dr. Wayne Bai, Dr. Puneeta Tandon

References:

  1. Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation. Am J Gastroenterol 2020 Jan;115(1):18-40. PMID 31895720
  2. Francoz C, Valla D, Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol 2012;57:203–12. PMID 22446690
  3. Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: Results of a longitudinal study. Hepatology 2015;61:660–7.PMID 25284616
  4. Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: Risk factors, screening, management, and outcome. Transplantation 2000;69:1873–81.PMID 10830225
  5. Kreuziger LB, Ageno W, Lee A. Management of incidental splanchnic vein thrombosis in cancer patients. Hematology Am Soc Hematol Educ Program 2014;2014:318–320. doi: 10.1182/asheducation-2014.1.318.PMID 25696872
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