New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

Nicoară-Farcău, Oana; Soy, Guillem; Magaz, Marta; Baiges, Anna; Turón, Fanny; García–Criado, Ángeles; Barrufet, Marta; Burrel, Marta; Hernández‐Gea, Virginia; García‐Pagán, Juan Carlos

doi:10.1055/s-0040-1715473

Cited by 19 publications

(22 citation statements)

References 85 publications

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“…The pathogenesis of a thrombus is generally multifactorial and it is believed that its occurrence is mainly determined by the interrelation of the three physiological factors of Virchow's triad: the hypercoagulability of the blood, the stasis of blood flow, and intravascular vessel wall damage [24,25]. Nevertheless, the exact contribution of each of these factors to PVT development has not been fully elucidated [26,27].…”

Section: Introductionmentioning

confidence: 99%

“…In this review, we aim to incorporate the latest studies on PVT development in the context of cirrhosis with the existent knowledge, as well as discuss all three vertices of Virchow's triad in detail and propose future directions for the advancement of this field. Both the clinical management of PVT and the invasion of the portal vein due to HCC, which have been reviewed elsewhere [27,28], are out of the scope of this review.…”

Section: Introductionmentioning

confidence: 99%

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The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Anton

Campreciós

Pérez-Campuzano

et al. 2022

JCM

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Portal vein thrombosis (PVT) is a common complication among patients with cirrhosis. However, its pathophysiology is not well established and there are currently very few predictive factors, none of which are actually useful, from a clinical perspective. The contribution of each of the vertices of Virchow’s triad, e.g., blood hypercoagulability, blood flow, and portal vein endothelial damage in the development of PVT is not clear. In this review, we aim to recapitulate the latest studies on the field of PVT development in order to understand its mechanisms and discuss some of the future directions in the study of this important complication of cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Anton

Campreciós

Pérez-Campuzano

et al. 2022

JCM

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“…Es gilt abzuwägen, ob diese Möglichkeiten aufgrund der schweren Leberdysfunktion mit kon-sekutiverBlutungsdiathese oderaberaufgrund des schlechten Allgemeinzustands eines Patienten mit fortgeschrittener Leberzirrhose nicht mehr zur Verfügung stehen. Auch die Möglichkeiten der Antikoagulation können bei diesen Patienten nicht immer komplett ausgeschöpft werden [2,3].…”

Section: Leberdysfunktion Kann Die Therapeutischen Möglichkeiten Beeiunclassified

Pfortaderthrombosen – therapeutische Möglichkeiten

2021

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Die Pfortaderthrombose (PVT) ist eine partielle oder komplette Verlegung der Pfortader durch thrombotisches Material [1]. Die Thrombose kann dabei im Pfortaderast selbst oder in ihren intrahe-patischenAufzweigungenentstehen;entsprechend klassifiziert man auch in eine intrahepatische oder extrahepatische PVT. Darüber hinaus kann die Thrombose eine weitere Ausdehnung in die Milzvene oder in die Vena (V.) mesenterica superior nehmen [1].

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“…In these studies, PVT appears to be a marker of cirrhosis severity, which is a confounder that predominantly determines disease progression. 76 However, these studies included very few patients who had complete PVT. It was reported that four of eight patients with complete PVT experiencing spontaneous improvement, at rates similar to those with non-complete PVT.…”

Section: Asymptomatic Pvt In Non-transplant Candidatesmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts in portal vein thrombosis: A review

Yeoh

Kok

2021

J of Digest Diseases

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The presence of portal vein thrombosis (PVT) has previously been considered a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS). However, patients with PVT may have portal hypertension complications and may thus benefit from TIPSS to reduce portal venous pressure. There is an increasing body of literature that discusses the techniques and outcomes of TIPSS in PVT. This review summarizes the techniques, indications and outcomes of TIPSS in PVT in published case reports, case series and comparative trials, especially regarding the reduction in portal hypertensive complications such as variceal bleeding. A comprehensive literature search was conducted using MEDLINE and PubMed databases.Manuscripts published in English between 1 January 1990 and 1 March 2021 were used. Abstracts were screened and data from potentially relevant articles analyzed.TIPSS in PVT has been reported with high levels of technical success, short-term portal vein recanalization and long-term PV patency and TIPSS patency outcomes. Several comparative studies, including randomized controlled trials, have shown favorable outcomes of TIPSS compared with non-TIPSS treatment of PVT complications. Outcomes of TIPSS with PVT appear similar to those in TIPSS without PVT.However, TIPSS may be more technically difficult in the presence of PVT, and such procedures should be performed in expert high-volume centers to mitigate the risk of procedural complications. The presence of PVT should no longer be considered a contraindication to TIPSS. TIPSS for PVT has been acknowledged as a therapeutic strategy in recent international guidelines, although further studies are needed before recommendations can be strengthened. Key Points• Portal vein thrombosis (PVT) is no longer a contraindication to the insertion of transjugular intrahepatic portosystemic shunts (TIPSS)• TIPSS often leads to the spontaneous dissolution of PVT, but can be combined with mechanical or pharmacological thrombectomy • TIPSS reduces portal hypertensive complications of PVT, such as variceal bleeding, and can also facilitate liver transplantation where PVT may otherwise interfere with vascular anastomoses • Studies have shown favorable long-term outcomes of TIPSS compared with TIPSS without PVT; as well as compared with non-TIPSS treatment of PVT complications

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New Insights into the Pathogenesis, Risk Factors, and Treatment of Portal Vein Thrombosis in Patients with Cirrhosis

Cited by 19 publications

References 85 publications

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow’s Triad

Pfortaderthrombosen – therapeutische Möglichkeiten

Transjugular intrahepatic portosystemic shunts in portal vein thrombosis: A review

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