Novel insights into the development of portal vein thrombosis in cirrhosis patients

Abstract

The prognostic impact of portal vein thrombosis (PVT) in liver cirrhosis remains controversial among studies, primarily because the risk stratification of PVT is often lacking. A definition of clinically significant PVT should be proposed and actively improved. Moreover, the risk factors for the development of PVT in liver cirrhosis should be fully recognized to screen and identify high-risk patients. Currently, well-recognized risk factors include a reduced portal vein flow velocity, a worse liver function, splenectomy, liver transplantation, and factor V Leiden and prothrombin G20210A mutations. Novel risk factors include an increased flow volume of portosystemic collateral vessel, thrombopoietin receptor agnonists, and non-selective beta-blockers. In contrast to the traditional perspectives, the abnormalities of procoagulant and anticoagulant factors may not contribute to the development of PVT in liver cirrhosis. Further studies should explore the role of other risk factors, such as antiphospholipid antibodies, methylenetetrahydrofolate reductase C677T gene mutation, hyperhomocysteinemia, and myeloproliferative neoplasms.

Portal cavernoma in a case of alcoholic liver disease with myeloproliferative neoplasm

“…Chronic liver disease, especially liver cirrhosis, is one of the most common causes of portal vein thrombosis (PVT) [1, 2]. Once chronic liver diseases are diagnosed in patients with PVT, further screening for other thrombotic risk factors is often neglected.…”

Efficacy and safety of anticoagulant therapy in patients with chronic cirrhosis complicated with portal vein thrombosis: what should we expert from a meta-analysis?

“…It was believed that the disorders in the synthesis of coagulation factors in cirrhotic patients would increase the risk of bleeding, which, however, is contradictory to non-malignant PVT in patients with cirrhosis. Some recent studies (12)(13)(14)have suggested that PVT in cirrhotic patients results from a variety of factors including the decreased portal vein ow velocities, portal vein lymphangitis, and portal brosis. It may also be because that the poor liver function in cirrhotic patients disrupts the balance between pro-and anti-coagulation factors.…”

Perioperative Thromboelastometry for Adult Living Donor Liver Transplant Recipients with a Tendency to Hypercoagulability: A Prospective Observational Cohort Study

“…Related to the patient population screened for this study (151 potential liver recipients), this corresponds to an incidence of 0.7% antiphospholipid antibodies, 6.6% for increased homocysteine, 7.9% for Factor V Leiden mutation, 11.3% for decreased protein S, 25.8% for decreased protein C, 24.5% for decreased anti-thrombin, and 25.2% for increased lupus anticoagulant. This high incidence of risk factors for thrombosis - in particular the high incidence of positive lupus anticoagulant testing - is an important finding and should lead to further studies in cooperation with other centers in Egypt and overseas to investigate whether this is a local problem or represents a general issue in patients on a liver transplant waiting list [21,22,23,24,25,26]. This would provide important information for developing a protocol for perioperative hemostasis management for recipients in this part of the world, which might be different from other protocols used in overseas centers.…”