Nonsurgical Therapeutic Options in Portal Vein Thrombosis

BACKGROUND: Portal vein thrombosis (PVT) is a rare but severe vascular disorder with an acute and a chronic course. Most patients have underlying liver cirrhosis; furthermore, thrombophilia is an important risk factor. However, idiopathic forms are also known. METHODS: This review discusses nonsurgical treatment options in PVT. RESULTS AND CONCLUSION: Therapy of acute PVT is based on anticoagulation with heparin that is switched to oral anticoagulants, if applicable. Catheter-guided invasive therapy should be considered; however, patients with liver cirrhosis should be screened for portal hypertension before anticoagulation is mandatory. Therapy of chronic PVT is discussed controversially; therefore, a strict patient selection and an individual therapeutic decision are warranted depending on the etiology of PVT. Special forms of PVT including septic and malignant thrombosis as well as PVT in patients waiting for liver transplantation require particular therapy algorithms.