Management of Acute Non‐cirrhotic and Non‐malignant Portal Vein Thrombosis: A Systematic Review

Abstract

The natural history of acute PVT is poorly described. Spontaneous resolution of acute portal vein thrombosis is uncommon. Early anticoagulation results in a satisfactory rate of recanalization with minimal procedure-associated morbidity. Thrombolysis should be used with caution and only considered if the disease is progressive and signs of mesenteric ischemia are present. Further well-designed trials with precise outcome reporting are needed to improve our understanding of the disease.

The Management of Mesenteric Vein Thrombosis: A Single Institution Experience

“…They also determined that at least six months of oral anticoagulation is effective in reducing long-term morbidity and mortality in cases of portal vein thrombosis occurring concurrently with SMV or SV. [20] Correspondingly, in cases with prothrombotic risk factors, long-term or life-long anticoagulant treatment could be considered, as stated in recent published consensus statements. [7,20,21] After diagnosis with MVT, anticoagulation should be started promptly with the administration of enoxaparin 100 mg/kg twice daily.…”

“…[20] Correspondingly, in cases with prothrombotic risk factors, long-term or life-long anticoagulant treatment could be considered, as stated in recent published consensus statements. [7,20,21] After diagnosis with MVT, anticoagulation should be started promptly with the administration of enoxaparin 100 mg/kg twice daily. The reported overall mortality rate of 50% in the literature is mainly attributed to difficulties in diagnosis and subsequent delay of necessary therapeutic intervention.…”

“…In a systematic review of management of acute non-cirrhotic and non-malignant portal vein thrombosis by Hall et al, [20] 29 articles with 315 patients were included, and treatments and outcomes were analyzed. They described the treatment modalities as conservative management, anticoagulation, and thrombolysis and thrombectomy.…”

Portal Vein Thrombosis

“…Most of the management decisions have to be individualized depending on the local expertise, since there is lack of randomized controlled trials. A systematic review reported that upto 117 A recent multicenter 2 year follow up study evaluated 102 patients of acute PVT unrelated to cirrhosis and anticoagulation was given in 95 patients. 45 Following anticoagulation 1 year portal vein recanalization rate was 39% and no recanalization occurred beyond 6 months after initiation of anticoagulation.…”

Portal vein thrombosis – a primer for the general physician

“…A 2011 systematic review showed that more than 80% of acute PVT cases do not resolve without the use of anticoagulation. 36 And for those that do recanalise without such drugs, it is either due to the spontaneous resolution of a self-limiting illness, such as acute pancreatitis, or due to the fact that the thrombosis load was very small. 36 In the systematic review, the time taken for recanalisation ranged from a few days to over 6 months indicating, in some cases, long-term anticoagulation may be needed for recanalisation.…”