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World J Gastroenterol. Aug 21, 2019; 25(31): 4437-4451
Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4437
Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate
Mariella Faccia, Maria Elena Ainora, Francesca Romana Ponziani, Laura Riccardi, Matteo Garcovich, Antonio Gasbarrini, Maurizio Pompili, Maria Assunta Zocco
Mariella Faccia, Maria Elena Ainora, Francesca Romana Ponziani, Laura Riccardi, Matteo Garcovich, Antonio Gasbarrini, Maurizio Pompili, Maria Assunta Zocco, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome 00168, Italy
Author contributions: Faccia M and Zocco MA conceived, wrote and revised the article; Ainora ME, Ponziani FR, Riccardi L, Gasbarrini A and Pompili M critically revised manuscript content; Garcovich M revised manuscript content and language.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mariella Faccia, MD, Academic Fellow, Doctor, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemelli 8, Rome 00168, Italy. mariellafaccia4@gmail.com
Telephone: +39-3405457425
Received: May 5, 2019
Peer-review started: May 5, 2019
First decision: June 10, 2019
Revised: July 8, 2019
Accepted: July 19, 2019
Article in press: July19, 2019
Published online: August 21, 2019
Abstract

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.

Keywords: Portal vein thrombosis, Liver cirrhosis, Hypercoagulability, Anticoagulation, Direct oral anticoagulants

Core tip: Portal vein thrombosis (PVT) represents a common and potential life-threating complication of liver cirrhosis. Anticoagulant therapy is advised in selected cases, in particular for liver transplant candidates. Despite the advanced knowledge in PVT pathogenesis and diagnosis, many issues regarding its natural history and prognostic outcome remain elusive. Likewise, the safer anticoagulant option, the potential role of direct oral anticoagulants and the optimal duration of therapy are still matter of debate. Given the clinical significance of this pathological entity, these cardinal issues should urgently be addressed in large prospective cohort studies and randomized trails.