J Clin Exp Hepatol. 2015 Mar;5(1):22-40. doi: 10.1016/j.jceh.2014.12.008. Epub 2015 Jan 06.
Portal vein thrombosis.
Journal of clinical and experimental hepatology
Yogesh K Chawla, Vijay Bodh
Affiliations
Affiliations
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
PMID: 25941431
PMCID: PMC4415192 DOI: 10.1016/j.jceh.2014.12.008
Abstract
Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion.
Keywords: ACLA, anti-cardiolipin antibody; AFP, alpha feto protein; BCS, Budd-Chiari syndrome; CDUS, color doppler ultrasonography; CT, computed tomography; CTP, Child Turcotte Pugh; EHPVO, extra hepatic portal venous obstruction; EST, endoscopic sclerotherapy; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; IGF-1, insulin like growth factor-1; IGFBP-3, insulin like growth factor binding protein-3; INR, international normalized ratio; JAK-2, Janus kinase 2; LA, lupus anticoagulant; LMWH, low molecular weight heparin; MELD, model for end stage liver disease; MPD, myeloproliferative disorder; MRI, magnetic resonance imaging; MTHFR, methylenetetrahydrofolate reductase; MVT, mesenteric vein thrombosis; OCPs, oral contraceptive pills; PAI-1 4G-4G, plasminogen activator inhibitor type 1- 4G/4G genotype; PNH, paroxysmal nocturnal hemoglobinuria; PV, portal vein; PVT; PVT, portal vein thrombosis; PWUS, Pulsed Wave ultrasonography; RFA, radio frequency ablation; SMA, superior mesenteric artery; SMV, superior mesenteric vein; TAFI, thrombin activatable fibrinolysis inhibitor; TARE, Trans arterial radioembolization; TB, tuberculosis; TIPS, transjugular intrahepatic portosystemic shunt; UFH, unfractionated heparin; acute and chronic; anticoagulation; imaging; prothrombotic; rtPA, recombinant tissue plasminogen activator
References
- Gastrointest Endosc. 1999 Mar;49(3 Pt 1):344-8 - PubMed
- Lancet. 1999 Apr 3;353(9159):1167-73 - PubMed
- Eur J Surg. 1999 Aug;165(8):777-81 - PubMed
- Gastrointest Endosc. 1999 Nov;50(5):646-52 - PubMed
- Arch Intern Med. 2000 Jan 24;160(2):181-8 - PubMed
- Hepatology. 2000 Feb;31(2):345-8 - PubMed
- Hepatology. 2000 Mar;31(3):587-91 - PubMed
- Gut. 2000 Apr;46(4):534-9 - PubMed
- Lancet. 2000 Mar 18;355(9208):987-8 - PubMed
- Indian J Pediatr. 1998 Jul-Aug;65(4):585-91 - PubMed
- AJR Am J Roentgenol. 2000 May;174(5):1447-53 - PubMed
- Transplantation. 2000 May 15;69(9):1873-81 - PubMed
- Radiology. 2000 Jul;216(1):86-92 - PubMed
- Endoscopy. 2000 Jul;32(7):520-4 - PubMed
- QJM. 2000 Aug;93(8):531-4 - PubMed
- Hepatology. 2000 Sep;32(3):466-70 - PubMed
- Pancreas. 2000 Aug;21(2):126-33 - PubMed
- Blood. 2000 Oct 1;96(7):2364-8 - PubMed
- Gastroenterology. 2001 Feb;120(2):490-7 - PubMed
- Liver Transpl. 2001 Feb;7(2):125-31 - PubMed
- Eur J Radiol. 2001 Aug;39(2):80-2 - PubMed
- Hepatology. 2001 Oct;34(4 Pt 1):666-70 - PubMed
- Gut. 2001 Nov;49(5):720-4 - PubMed
- N Engl J Med. 2001 Dec 6;345(23):1683-8 - PubMed
- J Gastroenterol Hepatol. 2001 Dec;16(12):1429-33 - PubMed
- Surg Laparosc Endosc Percutan Tech. 2002 Apr;12(2):131-6 - PubMed
- Am J Hematol. 2002 Jun;70(2):126-32 - PubMed
- Endoscopy. 2002 Jul;34(7):535-8 - PubMed
- Indian J Gastroenterol. 2002 Jul-Aug;21(4):162-3 - PubMed
- J Vasc Surg. 2002 Nov;36(5):1058-61 - PubMed
- J Gastroenterol Hepatol. 2002 Dec;17 Suppl 3:S224-7 - PubMed
- Gastrointest Endosc. 2003 Feb;57(2):269-71 - PubMed
- J Gastroenterol. 2003;38(1):101-3 - PubMed
- World J Gastroenterol. 2003 May;9(5):1114-8 - PubMed
- Tech Vasc Interv Radiol. 2003 Mar;6(1):59-69 - PubMed
- Hepatology. 2003 Jun;37(6):1302-8 - PubMed
- Am J Med Sci. 2003 Jun;325(6):365-8 - PubMed
- J Pediatr Surg. 2003 Jul;38(7):1008-11 - PubMed
- Langenbecks Arch Surg. 2003 Jul;388(3):141-9 - PubMed
- Hepatology. 1992 Dec;16(6):1343-9 - PubMed
- Gastrointest Endosc. 2003 Oct;58(4):602-8 - PubMed
- Clin Imaging. 2003 Nov-Dec;27(6):417-20 - PubMed
- Am Surg. 2003 Nov;69(11):951-6 - PubMed
- J Vasc Surg. 2003 Dec;38(6):1411-5 - PubMed
- Am J Gastroenterol. 2004 Jan;99(1):40-4 - PubMed
- Hepatogastroenterology. 2003 Nov-Dec;50(54):2098-100 - PubMed
- Semin Thromb Hemost. 1992;18(4):353-72 - PubMed
- Int Surg. 2003 Oct-Dec;88(4):184-7 - PubMed
- Liver Int. 2003 Dec;23(6):434-9 - PubMed
- J Vasc Interv Radiol. 2004 Apr;15(4):335-45 - PubMed
- J Hepatol. 2004 May;40(5):736-41 - PubMed
- Am J Clin Pathol. 2004 Jun;121(6):844-7 - PubMed
- Arq Gastroenterol. 2003 Oct-Dec;40(4):247-50 - PubMed
- J Pediatr Surg. 2004 Sep;39(9):1356-61 - PubMed
- Cardiovasc Intervent Radiol. 2004 Sep-Oct;27(5):474-80 - PubMed
- Gut. 1992 Feb;33(2):272-6 - PubMed
- J Comput Assist Tomogr. 2004 Nov-Dec;28(6):804-10 - PubMed
- Gastrointest Endosc. 2004 Dec;60(6):1021-4 - PubMed
- Aliment Pharmacol Ther. 2005 Jan 1;21(1):1-9 - PubMed
- Eur J Gastroenterol Hepatol. 2005 Mar;17(3):339-43 - PubMed
- Hepatology. 2005 Mar;41(3):603-8 - PubMed
- Gut. 2005 May;54(5):691-7 - PubMed
- J Vasc Interv Radiol. 2005 May;16(5):651-61 - PubMed
- J Hepatol. 2005 Jul;43(1):167-76 - PubMed
- Eur J Gastroenterol Hepatol. 2005 Jul;17(7):745-51 - PubMed
- J Clin Gastroenterol. 2005 Aug;39(7):626-9 - PubMed
- Swiss Med Wkly. 2005 Jun 25;135(25-26):372-6 - PubMed
- Liver Transpl. 2005 Nov;11(11):1389-94 - PubMed
- Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):515-8 - PubMed
- Indian J Gastroenterol. 2005 Sep-Oct;24(5):205-10 - PubMed
- Am J Gastroenterol. 2006 Jan;101(1):83-90 - PubMed
- J Pediatr Surg. 2006 Jan;41(1):108-12; discussion 108-12 - PubMed
- Dig Dis Sci. 2006 Jan;51(1):11-7 - PubMed
- Am Surg. 2005 Oct;71(10):856-60 - PubMed
- AJR Am J Roentgenol. 2006 Mar;186(3):763-73 - PubMed
- Eur J Gastroenterol Hepatol. 2006 Apr;18(4):443-5 - PubMed
- Hepatology. 2006 Apr;43(4):707-14 - PubMed
- World J Gastroenterol. 2006 Apr 7;12(13):2115-9 - PubMed
- Gastroenterology. 2006 Jun;130(7):2031-8 - PubMed
- Ann Surg. 2006 Jun;243(6):884-92; discussion 892-4 - PubMed
- Cardiovasc Intervent Radiol. 2006 Sep-Oct;29(5):785-90 - PubMed
- Indian J Gastroenterol. 2006 May-Jun;25(3):140-2 - PubMed
- Radiology. 2006 Oct;241(1):149-55 - PubMed
- Langenbecks Arch Surg. 2006 Sep;391(5):483-8 - PubMed
- Nat Clin Pract Gastroenterol Hepatol. 2006 Sep;3(9):505-15 - PubMed
- Liver Transpl. 2006 Nov;12(11):1682-8 - PubMed
- Indian J Gastroenterol. 2006 Sep-Oct;25(5):236-9 - PubMed
- Pediatr Transplant. 2006 Dec;10(8):908-13 - PubMed
- Clin Gastroenterol Hepatol. 2007 Jan;5(1):80-6 - PubMed
- Thromb Haemost. 2007 Feb;97(2):181-5 - PubMed
- Dig Dis Sci. 1992 Mar;37(3):340-6 - PubMed
- Abdom Imaging. 2008 Jan-Feb;33(1):65-71 - PubMed
- Blood. 2007 Aug 15;110(4):1092-7 - PubMed
- Am J Med. 2007 Jun;120(6):552.e9-11 - PubMed
- Trop Gastroenterol. 2006 Oct-Dec;27(4):147-53 - PubMed
- World J Gastroenterol. 2007 May 14;13(18):2535-40 - PubMed
- J Pediatr Surg. 2007 Jun;42(6):1137-40 - PubMed
- Cardiovasc Intervent Radiol. 2007 Nov-Dec;30(6):1222-6 - PubMed
- J Gastroenterol Hepatol. 2008 Sep;23(9):1354-7 - PubMed
- Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):1070-4 - PubMed
- Abdom Imaging. 2008 Jan-Feb;33(1):72-9 - PubMed
- BMC Gastroenterol. 2007 Aug 15;7:34 - PubMed
- Liver Transpl. 2007 Sep;13(9):1312-6 - PubMed
- Am J Gastroenterol. 2007 Nov;102(11):2464-70 - PubMed
- Clin Radiol. 2007 Dec;62(12):1180-8 - PubMed
- Clin Transplant. 2007 Nov-Dec;21(6):716-21 - PubMed
- Hepatology. 2008 Jan;47(1):71-81 - PubMed
- Thromb Res. 2008;122(3):299-306 - PubMed
- Dig Dis Sci. 2008 Jul;53(7):1994-9 - PubMed
- Gastrointest Endosc. 2008 May;67(6):821-7 - PubMed
- Blood. 2008 May 15;111(10):4922-9 - PubMed
- World J Gastroenterol. 2008 Feb 28;14(8):1212-7 - PubMed
- HPB (Oxford). 2007;9(5):352-6 - PubMed
- Eur Radiol. 2008 Aug;18(8):1749-56 - PubMed
- Surgery. 2008 Apr;143(4):476-82 - PubMed
- Indian J Gastroenterol. 2007 Nov-Dec;26(6):283-4 - PubMed
- AJR Am J Roentgenol. 1991 Aug;157(2):293-6 - PubMed
- J Thromb Thrombolysis. 2009 Jul;28(1):70-3 - PubMed
- J Pediatr Surg. 2008 Aug;43(8):e29-32 - PubMed
- J Gastroenterol Hepatol. 2008 Aug;23(8 Pt 1):1259-66 - PubMed
- Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1155-63 - PubMed
- Clin Gastroenterol Hepatol. 2008 Dec;6(12):1412-7 - PubMed
- Intern Emerg Med. 2009 Apr;4(2):161-2; author reply 163-4 - PubMed
- Thromb Haemost. 2008 Dec;100(6):1084-8 - PubMed
- Hepatobiliary Pancreat Dis Int. 2009 Feb;8(1):34-9 - PubMed
- Pediatr Transplant. 2009 Aug;13(5):540-4 - PubMed
- Clin Transplant. 2010 Jan-Feb;24(1):48-55 - PubMed
- J Hepatol. 2009 May;50(5):916-22 - PubMed
- Hepatology. 2009 May;49(5):1729-64 - PubMed
- J Hepatol. 2009 Oct;51(4):682-9 - PubMed
- Hepatol Int. 2009 Mar;3(1):305-9 - PubMed
- J Clin Gastroenterol. 2010 Jul;44(6):448-51 - PubMed
- Dig Liver Dis. 2010 Jun;42(6):451-5 - PubMed
- Hepatology. 2010 Jan;51(1):210-8 - PubMed
- Gastroenterology. 1991 Jan;100(1):160-7 - PubMed
- World J Gastroenterol. 2009 Oct 28;15(40):5028-34 - PubMed
- Am J Surg. 1991 Jan;161(1):76-82; discussion 82-3 - PubMed
- Indian J Gastroenterol. 2009 Dec;28(6):206-11 - PubMed
- Dig Liver Dis. 2011 Jan;43(1):78-84 - PubMed
- Abdom Imaging. 2011 Aug;36(4):390-8 - PubMed
- J Hepatol. 2011 Jan;54(1):78-88 - PubMed
- J Vasc Interv Radiol. 2011 Jan;22(1):61-9 - PubMed
- Aliment Pharmacol Ther. 2011 May;33(10):1087-103 - PubMed
- World J Surg. 2011 Nov;35(11):2510-20 - PubMed
- J Thromb Haemost. 2011 Nov;9(11):2208-14 - PubMed
- J Gastroenterol Hepatol. 2012 Jun;27(6):1036-43 - PubMed
- Dig Dis Sci. 2012 Apr;57(4):1072-82 - PubMed
- Clin Gastroenterol Hepatol. 2012 Jul;10(7):776-83 - PubMed
- Liver Int. 2012 Jul;32(6):919-27 - PubMed
- J Hepatol. 2012 Jul;57(1):203-12 - PubMed
- Trop Gastroenterol. 2011 Oct-Dec;32(4):279-84 - PubMed
- Gastroenterology. 2012 Nov;143(5):1253-1260.e4 - PubMed
- J Hepatol. 2012 Dec;57(6):1214-9 - PubMed
- Radiology. 2012 Oct;265(1):124-32 - PubMed
- Hepatology. 2013 May;57(5):1826-37 - PubMed
- Blood. 2012 Dec 13;120(25):4921-8 - PubMed
- Transplantation. 2012 Dec 15;94(11):1145-53 - PubMed
- J Gastroenterol Hepatol. 2013 Mar;28(3):432-42 - PubMed
- J Thromb Haemost. 2013 Mar;11(3):452-9 - PubMed
- Dig Dis Sci. 2013 Jun;58(6):1776-80 - PubMed
- Am J Gastroenterol. 2013 Apr;108(4):568-74 - PubMed
- Can Assoc Radiol J. 1990 Jun;41(3):146-8 - PubMed
- Ann Vasc Surg. 2013 May;27(4):497.e1-4 - PubMed
- Thromb Haemost. 2013 Oct;110(4):626-7 - PubMed
- Hepatology. 2014 Jul;60(1):425-6 - PubMed
- Int J Vasc Med. 2013;2013:717480 - PubMed
- Gastroenterol Res Pract. 2014;2014:659726 - PubMed
- AJR Am J Roentgenol. 1989 Apr;152(4):765-70 - PubMed
- Gastroenterology. 1989 Aug;97(2):421-6 - PubMed
- Edinb Med J. 1869 Jan;14(7):589-598 - PubMed
- Gastroenterology. 1988 Apr;94(4):1063-9 - PubMed
- Ann Surg. 1986 Mar;203(3):286-91 - PubMed
- Hepatogastroenterology. 1985 Oct;32(5):224-5 - PubMed
- AJR Am J Roentgenol. 1985 Apr;144(4):749-52 - PubMed
- Surg Gynecol Obstet. 1985 Jul;161(1):66-8 - PubMed
- Gastroenterology. 1985 Aug;89(2):279-86 - PubMed
- Arch Surg. 1974 Mar;108(3):338-41 - PubMed
- Hepatology. 1995 May;21(5):1226-31 - PubMed
- Br J Surg. 1994 Sep;81(9):1328-31 - PubMed
- AJR Am J Roentgenol. 1994 Mar;162(3):643-5 - PubMed
- J Pediatr Gastroenterol Nutr. 1993 Nov;17(4):392-6 - PubMed
- AJR Am J Roentgenol. 1994 Jan;162(1):77-81 - PubMed
- Hepatology. 1993 May;17(5):807-13 - PubMed
- Arch Dis Child. 1977 May;52(5):383-5 - PubMed
- Am J Surg. 1996 Nov;172(5):449-52; discussion 452-3 - PubMed
- J Gastroenterol Hepatol. 1997 Aug;12(8):582-4 - PubMed
- J Pediatr Gastroenterol Nutr. 1997 Nov;25(5):520-3 - PubMed
- J Hepatol. 1999 Jan;30(1):29-37 - PubMed
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