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Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis
Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dysfunction have emerged as key factors in the pathogenesis...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
XIA & HE Publishing Inc.
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782107/ https://www.ncbi.nlm.nih.gov/pubmed/33447527 http://dx.doi.org/10.14218/JCTH.2020.00067 |
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author | Rugivarodom, Manus Charatcharoenwitthaya, Phunchai |
author_facet | Rugivarodom, Manus Charatcharoenwitthaya, Phunchai |
author_sort | Rugivarodom, Manus |
collection | PubMed |
description | Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dysfunction have emerged as key factors in the pathogenesis of PVT. The contribution of PVT to hepatic decompensation and mortality in cirrhosis is debatable; however, the presence of an advanced PVT increases operative complexity and decreases survival after transplantation. The therapeutic decision for PVT is often determined by the duration and extent of thrombosis, the presence of symptoms, and liver transplant eligibility. Evidence from several cohorts has demonstrated that anticoagulation treatment with vitamin K antagonist or low molecular weight heparin can achieve recanalization of the portal vein, which is associated with a reduction in portal hypertension-related events and improved survival in cirrhotic patients with PVT. Consequently, interest in direct oral anticoagulants for PVT is increasing, but clinical data in cirrhosis are limited. Although the most feared consequence of anticoagulation is bleeding, most studies indicate that anticoagulation therapy for PVT in cirrhosis appears relatively safe. Interestingly, the data showed that transjugular intrahepatic portosystemic shunt represents an effective adjunctive therapy for PVT in cirrhotic patients with symptomatic portal hypertension if anticoagulation is ineffective. Insufficient evidence regarding the optimal timing, modality, and duration of therapy makes nontumoral PVT a challenging consequence of cirrhosis. In this review, we summarize the current literature and provide a potential algorithm for the management of PVT in patients with cirrhosis. |
format | Online Article Text |
id | pubmed-7782107 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | XIA & HE Publishing Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77821072021-01-13 Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis Rugivarodom, Manus Charatcharoenwitthaya, Phunchai J Clin Transl Hepatol Review Article Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dysfunction have emerged as key factors in the pathogenesis of PVT. The contribution of PVT to hepatic decompensation and mortality in cirrhosis is debatable; however, the presence of an advanced PVT increases operative complexity and decreases survival after transplantation. The therapeutic decision for PVT is often determined by the duration and extent of thrombosis, the presence of symptoms, and liver transplant eligibility. Evidence from several cohorts has demonstrated that anticoagulation treatment with vitamin K antagonist or low molecular weight heparin can achieve recanalization of the portal vein, which is associated with a reduction in portal hypertension-related events and improved survival in cirrhotic patients with PVT. Consequently, interest in direct oral anticoagulants for PVT is increasing, but clinical data in cirrhosis are limited. Although the most feared consequence of anticoagulation is bleeding, most studies indicate that anticoagulation therapy for PVT in cirrhosis appears relatively safe. Interestingly, the data showed that transjugular intrahepatic portosystemic shunt represents an effective adjunctive therapy for PVT in cirrhotic patients with symptomatic portal hypertension if anticoagulation is ineffective. Insufficient evidence regarding the optimal timing, modality, and duration of therapy makes nontumoral PVT a challenging consequence of cirrhosis. In this review, we summarize the current literature and provide a potential algorithm for the management of PVT in patients with cirrhosis. XIA & HE Publishing Inc. 2020-11-11 2020-12-28 /pmc/articles/PMC7782107/ /pubmed/33447527 http://dx.doi.org/10.14218/JCTH.2020.00067 Text en © 2020 Authors. http://creativecommons.org/licenses/by-nc/4.0/ This article has been published under the terms of Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), which permits noncommercial unrestricted use, distribution, and reproduction in any medium, provided that the following statement is provided. “This article has been published in Journal of Clinical and Translational Hepatology at DOI: 10.14218/JCTH.2020.00067 and can also be viewed on the Journal’s website at http://www.jcthnet.com”. |
spellingShingle | Review Article Rugivarodom, Manus Charatcharoenwitthaya, Phunchai Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title | Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title_full | Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title_fullStr | Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title_full_unstemmed | Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title_short | Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis |
title_sort | nontumoral portal vein thrombosis: a challenging consequence of liver cirrhosis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782107/ https://www.ncbi.nlm.nih.gov/pubmed/33447527 http://dx.doi.org/10.14218/JCTH.2020.00067 |
work_keys_str_mv | AT rugivarodommanus nontumoralportalveinthrombosisachallengingconsequenceoflivercirrhosis AT charatcharoenwitthayaphunchai nontumoralportalveinthrombosisachallengingconsequenceoflivercirrhosis |