Download PDF
Semin Liver Dis
DOI: 10.1055/s-0044-1791247
Review Article

Management of Portal vein Thrombosis in Cirrhosis

Babu Lal Meena
1   Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
,
Shiv Kumar Sarin
1   Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
› Author Affiliations
› Further Information
    Permissions and Reprints


Abstract

Portal vein thrombosis (PVT) is one of the common complications of cirrhosis. The incidence of PVT correlates with liver disease severity—higher incidence in patients with Child–Turcotte–Pugh (CTP) C, large spontaneous portosystemic shunts, hepatofugal portal flow, and in the presence of hepatocellular carcinoma. PVT may worsen ascites, increase the risk and poor control of variceal bleeding. The occurrence of PVT may increase morbidity and lower survival after a liver transplant. Using statins prevents the occurrence of PVT, whereas beta-blockers may aggravate its occurrence. Cross-sectional imaging is mandatory for the precise diagnosis and classification of PVT. Symptomatic, occlusive PVT and candidacy for liver transplantation are the main indications for anticoagulation. Vitamin K antagonists, low-molecular-weight heparin, and newer anticoagulants are effective and safe in cirrhosis. Direct-acting oral anticoagulants are agents of choice in early cirrhosis (CTP A, B). The duration of anticoagulant therapy, predictors of response, and management of complications of cirrhosis while on therapy require in-depth knowledge and individualized treatment. Transjugular intrahepatic porto-systemic shunt can be considered in nonresponsive cases or when anticoagulants are contraindicated. This manuscript reviews the latest updated knowledge about managing PVT in cirrhosis.

Keywords

thrombosis - EHPVO - portal hypertension - anticoagulants - TIPS


Publication History

Article published online:
04 October 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Intagliata NM, Argo CK, Stine JG, Lisman T, Caldwell SH, Violi F. faculty of the 7th International Coagulation in Liver Disease. Concepts and Controversies in Haemostasis and Thrombosis Associated with Liver Disease: Proceedings of the 7th International Coagulation in Liver Disease Conference. Thromb Haemost 2018; 118 (08) 1491-1506
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Stine JG, Wang J, Shah PM. et al. Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study. Liver Int 2018; 38 (01) 94-101
    CrossrefPubMedGoogle Scholar
  • 3 Senzolo M, Shalaby S, Grasso M. et al. Role of nonneoplastic PVT in the natural history of patients with cirrhosis and first diagnosis of HCC. Hepatology 2024; 79 (02) 355-367
    PubMedGoogle Scholar
  • 4 Pan J, Wang L, Gao F. et al. Epidemiology of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Eur J Intern Med 2022; 104: 21-32
    CrossrefPubMedGoogle Scholar
  • 5 Mähringer-Kunz A, Meyer FI, Hahn F. et al. Hepatic vein tumor thrombosis in patients with hepatocellular carcinoma: prevalence and clinical significance. United European Gastroenterol J 2021; 9 (05) 590-597
    CrossrefPubMedGoogle Scholar
  • 6 Catania R, Chupetlovska K, Borhani AA, Maheshwari E, Furlan A. Tumor in vein (LR-TIV) and liver imaging reporting and data system (LI-RADS) v2018: diagnostic features, pitfalls, prognostic and management implications. Abdom Radiol (NY) 2021; 46 (12) 5723-5734
    CrossrefPubMedGoogle Scholar
  • 7 Sarin SK, Sollano JD, Chawla YK. et al; Members of the APASL Working Party on Portal Hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26 (05) 512-519
    CrossrefPubMedGoogle Scholar
  • 8 Hepatobiliary Disease Study Group, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus for management of portal vein thrombosis in liver cirrhosis (2020, Shanghai). J Dig Dis 2021; 22 (04) 176-186
    CrossrefPubMedGoogle Scholar
  • 9 Ponziani FR, Zocco MA, Senzolo M, Pompili M, Gasbarrini A, Avolio AW. Portal vein thrombosis and liver transplantation: implications for waiting list period, surgical approach, early and late follow-up. Transplant Rev (Orlando) 2014; 28 (02) 92-101
    CrossrefPubMedGoogle Scholar
  • 10 Bagot CN, Arya R. Virchow and his triad: a question of attribution. Br J Haematol 2008; 143 (02) 180-190
    CrossrefPubMedGoogle Scholar
  • 11 Biolato M, Paratore M, Di Gialleonardo L, Marrone G, Grieco A. Direct oral anticoagulant administration in cirrhotic patients with portal vein thrombosis: what is the evidence?. World J Hepatol 2022; 14 (04) 682-695
    CrossrefPubMedGoogle Scholar
  • 12 Saugel B, Lee M, Feichtinger S, Hapfelmeier A, Schmid RM, Siveke JT. Thrombophilic factor analysis in cirrhotic patients with portal vein thrombosis. J Thromb Thrombolysis 2015; 40 (01) 54-60
    CrossrefPubMedGoogle Scholar
  • 13 Fiorini A, Chiusolo P, Rossi E. et al. Absence of the JAK2 exon 12 mutations in patients with splanchnic venous thrombosis and without overt myeloproliferative neoplasms. Am J Hematol 2009; 84 (02) 126-127
    CrossrefPubMedGoogle Scholar
  • 14 Søgaard KK, Horváth-Puhó E, Grønbaek H, Jepsen P, Vilstrup H, Sørensen HT. Risk of venous thromboembolism in patients with liver disease: a nationwide population-based case-control study. Am J Gastroenterol 2009; 104 (01) 96-101
    CrossrefPubMedGoogle Scholar
  • 15 Xu X, Guo X, De Stefano V. et al. Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis. Hepatol Int 2019; 13 (04) 468-481
    CrossrefPubMedGoogle Scholar
  • 16 Nery F, Correia S, Macedo C. et al. Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study. Aliment Pharmacol Ther 2019; 49 (05) 582-588
    CrossrefPubMedGoogle Scholar
  • 17 Stupia R, Lombardi R, Cattazzo F. et al. Prevalence of portal vein thrombosis in non-alcoholic fatty liver disease: a meta-analysis of observational studies. . J Thromb Thrombolysis 2023
    PubMedGoogle Scholar
  • 18 Mandorfer M, Turon F, Lens S. et al. Risk of non-tumoural portal vein thrombosis in patients with HCV-induced cirrhosis after sustained virological response. Liver Int 2021; 41 (12) 2954-2964
    CrossrefPubMedGoogle Scholar
  • 19 Violi F, Ferro D. Clotting activation and hyperfibrinolysis in cirrhosis: implication for bleeding and thrombosis. Semin Thromb Hemost 2013; 39 (04) 426-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Carnevale R, Raparelli V, Nocella C. et al. Gut-derived endotoxin stimulates factor VIII secretion from endothelial cells. Implications for hypercoagulability in cirrhosis. J Hepatol 2017; 67 (05) 950-956
    CrossrefPubMedGoogle Scholar
  • 21 Suda T, Takatori H, Hayashi T. et al. Plasma antithrombin III levels can be a prognostic factor in liver cirrhosis patients with portal vein thrombosis. Int J Mol Sci 2023; 24 (09) 7732
    CrossrefPubMedGoogle Scholar
  • 22 Driever EG, von Meijenfeldt FA, Adelmeijer J. et al. Nonmalignant portal vein thrombi in patients with cirrhosis consist of intimal fibrosis with or without a fibrin-rich thrombus. Hepatology 2022; 75 (04) 898-911
    CrossrefPubMedGoogle Scholar
  • 23 Praktiknjo M, Trebicka J, Carnevale R. et al. Von Willebrand and factor VIII portosystemic circulation gradient in cirrhosis: implications for portal vein thrombosis. Clin Transl Gastroenterol 2020; 11 (02) e00123
    CrossrefPubMedGoogle Scholar
  • 24 Kapiotis S, Besemer J, Bevec D. et al. Interleukin-4 counteracts pyrogen-induced downregulation of thrombomodulin in cultured human vascular endothelial cells. Blood 1991; 78 (02) 410-415
    CrossrefPubMedGoogle Scholar
  • 25 Queck A, Carnevale R, Uschner FE. et al. Role of portal venous platelet activation in patients with decompensated cirrhosis and TIPS. Gut 2020; 69 (08) 1535-1536
    CrossrefPubMedGoogle Scholar
  • 26 Zocco MA, Di Stasio E, De Cristofaro R. et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51 (04) 682-689
    CrossrefPubMedGoogle Scholar
  • 27 Abdel-Razik A, Mousa N, Elhelaly R, Tawfik A. De-novo portal vein thrombosis in liver cirrhosis: risk factors and correlation with the model for end-stage liver disease scoring system. Eur J Gastroenterol Hepatol 2015; 27 (05) 585-592
    CrossrefPubMedGoogle Scholar
  • 28 Maruyama H, Okugawa H, Takahashi M, Yokosuka O. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. Am J Gastroenterol 2013; 108 (04) 568-574
    CrossrefPubMedGoogle Scholar
  • 29 Yuan HL, Wang M, Chu WW, Li FX, Lu JJ, Li Y. Nomogram model for prediction of portal vein thrombosis in patients with liver cirrhosis after splenectomy: a retrospective analysis of 2 independent cohorts. Med Sci Monit 2021; 27: e929844
    PubMedGoogle Scholar
  • 30 Ding J, Zhao F, Miao Y, Liu Y, Zhang H, Zhao W. Nomogram for predicting portal vein thrombosis in cirrhotic patients: a retrospective cohort study. J Pers Med 2023; 13 (01) 103
    CrossrefPubMedGoogle Scholar
  • 31 Gaballa D, Bezinover D, Kadry Z. et al. Development of a model to predict portal vein thrombosis in liver transplant candidates: the portal vein thrombosis risk index. Liver Transpl 2019; 25 (12) 1747-1755
    CrossrefPubMedGoogle Scholar
  • 32 Margini C, Berzigotti A. Portal vein thrombosis: the role of imaging in the clinical setting. Dig Liver Dis 2017; 49 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 33 Intagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology 2019; 156 (06) 1582-1599.e1
    CrossrefPubMedGoogle Scholar
  • 34 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
    CrossrefPubMedGoogle Scholar
  • 35 Mathieu D, Vasile N, Grenier P. Portal thrombosis: dynamic CT features and course. Radiology 1985; 154 (03) 737-741
    CrossrefPubMedGoogle Scholar
  • 36 Lee HK, Park SJ, Yi BH, Yeon EK, Kim JH, Hong HS. Portal vein thrombosis: CT features. Abdom Imaging 2008; 33 (01) 72-79
    CrossrefPubMedGoogle Scholar
  • 37 Raab BW. The thread and streak sign. Radiology 2005; 236 (01) 284-285
    CrossrefPubMedGoogle Scholar
  • 38 Tublin ME, Dodd III GD, Baron RL. Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol 1997; 168 (03) 719-723
    CrossrefPubMedGoogle Scholar
  • 39 Sherman CB, Behr S, Dodge JL, Roberts JP, Yao FY, Mehta N. Distinguishing tumor from bland portal vein thrombus in liver transplant candidates with hepatocellular carcinoma: the A-VENA Criteria. Liver Transpl 2019; 25 (02) 207-216
    CrossrefPubMedGoogle Scholar
  • 40 Yerdel MA, Gunson B, Mirza D. et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation 2000; 69 (09) 1873-1881
    CrossrefPubMedGoogle Scholar
  • 41 Senzolo M, Garcia-Tsao G, García-Pagán JC. Current knowledge and management of portal vein thrombosis in cirrhosis. J Hepatol 2021; 75 (02) 442-453
    CrossrefPubMedGoogle Scholar
  • 42 de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty BV. Baveno VII Faculty. Baveno VII - renewing consensus in portal hypertension. J Hepatol 2022; 76 (04) 959-974
    CrossrefPubMedGoogle Scholar
  • 43 Sarin SK, Philips CA, Kamath PS. et al. Toward a comprehensive new classification of portal vein thrombosis in patients with cirrhosis. Gastroenterology 2016; 151 (04) 574-577.e3
    CrossrefPubMedGoogle Scholar
  • 44 de Franchis R, Faculty BV. Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (03) 743-752
    CrossrefPubMedGoogle Scholar
  • 45 Loffredo L, Pastori D, Farcomeni A, Violi F. Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and meta-analysis. Gastroenterology 2017; 153 (02) 480-487.e1
    CrossrefPubMedGoogle Scholar
  • 46 Nery F, Chevret S, Condat B. et al; Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology 2015; 61 (02) 660-667
    CrossrefPubMedGoogle Scholar
  • 47 Senzolo M, MSartori T, Rossetto V. et al. Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int 2012; 32 (06) 919-927
    CrossrefPubMedGoogle Scholar
  • 48 Hidaka H, Kokubu S, Sato T. et al; NPB-06 study group. Antithrombin III for portal vein thrombosis in patients with liver disease: a randomized, double-blind, controlled trial. Hepatol Res 2018; 48 (03) E107-E116
    CrossrefPubMedGoogle Scholar
  • 49 Xu S, Guo X, Xu X. et al. Natural history and predictors associated with the evolution of portal venous system thrombosis in liver cirrhosis. Eur J Gastroenterol Hepatol 2021; 33 (1S, Suppl 1): e423-e430
    CrossrefPubMedGoogle Scholar
  • 50 Naymagon L, Tremblay D, Zubizarreta N, Moshier E, Mascarenhas J, Schiano T. Safety, efficacy, and long-term outcomes of anticoagulation in cirrhotic portal vein thrombosis. Dig Dis Sci 2021; 66 (10) 3619-3629
    CrossrefPubMedGoogle Scholar
  • 51 Luca A, Caruso S, Milazzo M. et al. Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 2012; 265 (01) 124-132
    CrossrefPubMedGoogle Scholar
  • 52 Zhang Y, Xu BY, Wang XB. et al. Prevalence and clinical significance of portal vein thrombosis in patients with cirrhosis and acute decompensation. Clin Gastroenterol Hepatol 2020; 18 (11) 2564-2572.e1
    CrossrefPubMedGoogle Scholar
  • 53 Amitrano L, Guardascione MA, Manguso F. et al. The effectiveness of current acute variceal bleed treatments in unselected cirrhotic patients: refining short-term prognosis and risk factors. Am J Gastroenterol 2012; 107 (12) 1872-1878
    CrossrefPubMedGoogle Scholar
  • 54 Zanetto A, Rodriguez-Kastro KI, Germani G. et al. Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis. Transpl Int 2018; 31 (12) 1318-1329
    CrossrefPubMedGoogle Scholar
  • 55 Rodríguez-Castro KI, Porte RJ, Nadal E, Germani G, Burra P, Senzolo M. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation 2012; 94 (11) 1145-1153
    CrossrefPubMedGoogle Scholar
  • 56 Ravaioli M, Zanello M, Grazi GL. et al. Portal vein thrombosis and liver transplantation: evolution during 10 years of experience at the University of Bologna. Ann Surg 2011; 253 (02) 378-384
    CrossrefPubMedGoogle Scholar
  • 57 Yeo JW, Law MSN, Lim JCL. et al. Meta-analysis and systematic review: prevalence, graft failure, mortality, and post-operative thrombosis in liver transplant recipients with pre-operative portal vein thrombosis. Clin Transplant 2022; 36 (02) e14520
    CrossrefPubMedGoogle Scholar
  • 58 Amjad W, Jiang Z, Lai M. Statin use in cirrhosis and its association with incidence of portal vein thrombosis. J Gastroenterol Hepatol 2024; 39 (05) 955-963
    CrossrefPubMedGoogle Scholar
  • 59 Huang XY, Zhang YH, Yi SY. et al. Potential contribution of the gut microbiota to the development of portal vein thrombosis in liver cirrhosis. Front Microbiol 2023; 14: 1217338
    CrossrefPubMedGoogle Scholar
  • 60 Villa E, Cammà C, Marietta M. et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology 2012; 143 (05) 1253-1260.e4
    CrossrefPubMedGoogle Scholar
  • 61 Qi X, Guo X, Yoshida EM. et al. Transient portal vein thrombosis in liver cirrhosis. BMC Med 2018; 16 (01) 83
    CrossrefPubMedGoogle Scholar
  • 62 Campoverde-Espinoza CA, Martínez-Tovar A, Higuera de la Tijera F. Prevalence and characteristics of portal vein recanalization in cirrhotic patients admitted with portal thrombosis in a third level care center. Annal of Hepatol 2022; 27: 100593
    CrossrefPubMedGoogle Scholar
  • 63 Giri S, Singh A, Kolhe K, Kale A, Shukla A. Natural history of portal vein thrombosis in cirrhosis: A systematic review with meta-analysis. J Gastroenterol Hepatol 2023; 38 (10) 1710-1717
    CrossrefPubMedGoogle Scholar
  • 64 De Santis A, Moscatelli R, Catalano C. et al. Systemic thrombolysis of portal vein thrombosis in cirrhotic patients: a pilot study. Dig Liver Dis 2010; 42 (06) 451-455
    CrossrefPubMedGoogle Scholar
  • 65 Senzolo M, Riva N, Dentali F, Sartori MT, Ageno W, Investigators IS. IRSVT Study Investigators. Portal vein thrombosis in decompensated cirrhosis: rationale for treatment. Clin Transl Gastroenterol 2019; 10 (04) e00026
    CrossrefPubMedGoogle Scholar
  • 66 La Mura V, Braham S, Tosetti G. et al. Harmful and beneficial effects of anticoagulants in patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2018; 16 (07) 1146-1152.e4
    CrossrefPubMedGoogle Scholar
  • 67 Delgado MG, Seijo S, Yepes I. et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10 (07) 776-783
    CrossrefPubMedGoogle Scholar
  • 68 Senzolo M, Riva N, Dentali F. et al; IRSVT study investigators. Long-term outcome of splanchnic vein thrombosis in cirrhosis. Clin Transl Gastroenterol 2018; 9 (08) 176
    CrossrefPubMedGoogle Scholar
  • 69 Wang L, Guo X, Xu X. et al. Anticoagulation favors thrombus recanalization and survival in patients with liver cirrhosis and portal vein thrombosis: results of a meta-analysis. Adv Ther 2021; 38 (01) 495-520
    CrossrefPubMedGoogle Scholar
  • 70 Pettinari I, Vukotic R, Stefanescu H. et al; BO-LIVES (BOlogna LIVEr vascular Studies). Clinical impact and safety of anticoagulants for portal vein thrombosis in cirrhosis. Am J Gastroenterol 2019; 114 (02) 258-266
    CrossrefPubMedGoogle Scholar
  • 71 Guerrero A, Campo LD, Piscaglia F. et al; Baveno Cooperation: an EASL consortium. Anticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: the IMPORTAL competing-risk meta-analysis. J Hepatol 2023; 79 (01) 69-78
    CrossrefPubMedGoogle Scholar
  • 72 Malkowski P, Pawlak J, Michalowicz B. et al. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003; 50 (54) 2098-2100
    PubMedGoogle Scholar
  • 73 Blum U, Haag K, Rössle M. et al. Noncavernomatous portal vein thrombosis in hepatic cirrhosis: treatment with transjugular intrahepatic portosystemic shunt and local thrombolysis. Radiology 1995; 195 (01) 153-157
    CrossrefPubMedGoogle Scholar
  • 74 Rosenqvist K, Eriksson LG, Rorsman F, Sangfelt P, Nyman R. Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver. Acta Radiol 2016; 57 (05) 572-579
    CrossrefPubMedGoogle Scholar
  • 75 Jiang TT, Luo XP, Sun JM, Gao J. Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis. World J Gastroenterol 2017; 23 (41) 7470-7477
    CrossrefPubMedGoogle Scholar
  • 76 Ageno W, Riva N, Schulman S. et al. Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry. JAMA Intern Med 2015; 175 (09) 1474-1480
    CrossrefPubMedGoogle Scholar
  • 77 Rodriguez-Castro KI, Vitale A, Fadin M. et al. A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis. Eur J Gastroenterol Hepatol 2019; 31 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 78 Ghabril M, Agarwal S, Lacerda M, Chalasani N, Kwo P, Tector AJ. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation 2016; 100 (01) 126-133
    CrossrefPubMedGoogle Scholar
  • 79 Senzolo M, Riggio O, Primignani M. Italian Association for the Study of the Liver (AISF) ad hoc. Vascular disorders of the liver: recommendations from the Italian Association for the Study of the Liver (AISF) ad hoc committee. Dig Liver Dis 2011; 43 (07) 503-514
    CrossrefPubMedGoogle Scholar
  • 80 Baiges A, Procopet B, Silva-Junior G. et al; REHEVASC, VALDIG, an EASL consortium. Incidence and factors predictive of recurrent thrombosis in people with non-cirrhotic portal vein thrombosis. J Hepatol 2023; 78 (01) 114-122
    CrossrefPubMedGoogle Scholar
  • 81 Deep venous thrombosis and pulmonary embolism. Part 1. Initial treatment: usually a low-molecular-weight heparin. Prescrire Int 2013; 22 (137) 99-101 , 103–104
    PubMedGoogle Scholar
  • 82 Eck RJ, Bult W, Wetterslev J. et al. Low dose low-molecular-weight heparin for thrombosis prophylaxis: systematic review with meta-analysis and trial sequential analysis. J Clin Med 2019; 8 (12) 2039
    CrossrefPubMedGoogle Scholar
  • 83 Senzolo M, Rodriguez-Castro KI, Rossetto V. et al. Increased anticoagulant response to low-molecular-weight heparin in plasma from patients with advanced cirrhosis. J Thromb Haemost 2012; 10 (09) 1823-1829
    CrossrefPubMedGoogle Scholar
  • 84 Koh JH, Liew ZH, Ng GK. et al. Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: a systematic review and meta-analysis. Dig Liver Dis 2022; 54 (01) 56-62
    CrossrefPubMedGoogle Scholar
  • 85 Lu S, Chen J, Zhang R. et al. Comparative effectiveness of warfarin in cirrhotic patients with non-symptomatic portal vein thrombosis: a multicenter, randomized controlled trial. Expert Rev Gastroenterol Hepatol 2024; 18 (1–3): 5-12
    CrossrefPubMedGoogle Scholar
  • 86 Chen H, Liu L, Qi X. et al. Efficacy and safety of anticoagulation in more advanced portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2016; 28 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 87 Buller HR, Sohne M, Middeldorp S. Treatment of venous thromboembolism. J Thromb Haemost 2005; 3 (08) 1554-1560
    CrossrefPubMedGoogle Scholar
  • 88 Heestermans M, Poenou G, Hamzeh-Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: a short history, their mechanism of action, pharmacology, and indications. Cells 2022; 11 (20) 3214
    CrossrefPubMedGoogle Scholar
  • 89 Ai MH, Dong WG, Tan XP. et al. Efficacy and safety study of direct-acting oral anticoagulants for the treatment of chronic portal vein thrombosis in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2020; 32 (10) 1395-1400
    CrossrefPubMedGoogle Scholar
  • 90 Intagliata NM, Henry ZH, Maitland H. et al. Direct oral anticoagulants in cirrhosis patients pose similar risks of bleeding when compared to traditional anticoagulation. Dig Dis Sci 2016; 61 (06) 1721-1727
    CrossrefPubMedGoogle Scholar
  • 91 De Gottardi A, Trebicka J, Klinger C. et al; VALDIG Investigators. Antithrombotic treatment with direct-acting oral anticoagulants in patients with splanchnic vein thrombosis and cirrhosis. Liver Int 2017; 37 (05) 694-699
    CrossrefPubMedGoogle Scholar
  • 92 Hum J, Shatzel JJ, Jou JH, Deloughery TG. The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. Eur J Haematol 2017; 98 (04) 393-397
    CrossrefPubMedGoogle Scholar
  • 93 Zhou H, Wu M, Yu S. et al. Comparison of the efficacy and safety between rivaroxaban and dabigatran in the treatment of acute portal vein thrombosis in cirrhosis. BMC Gastroenterol 2023; 23 (01) 329
    CrossrefPubMedGoogle Scholar
  • 94 Nagaoki Y, Aikata H, Daijyo K. et al. Efficacy and safety of edoxaban for treatment of portal vein thrombosis following danaparoid sodium in patients with liver cirrhosis. Hepatol Res 2018; 48 (01) 51-58
    CrossrefPubMedGoogle Scholar
  • 95 Godon A, Gabin M, Levy JH. et al; GIHP-NACO Study Group. Management of urgent invasive procedures in patients treated with direct oral anticoagulants: an observational registry analysis. Thromb Res 2022; 216: 106-112
    CrossrefPubMedGoogle Scholar
  • 96 Chaudhary R, Singh A, Chaudhary R. et al. Evaluation of direct oral anticoagulant reversal agents in intracranial hemorrhage: a systematic review and meta-analysis. JAMA Netw Open 2022; 5 (11) e2240145
    CrossrefPubMedGoogle Scholar
  • 97 Weinberg EM, Palecki J, Reddy KR. Direct-acting oral anticoagulants (DOACs) in cirrhosis and cirrhosis-associated portal vein thrombosis. Semin Liver Dis 2019; 39 (02) 195-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • 98 Diesveld MME, Pijnenburg DWMJ, Weersink RA. et al. Recommendations for the safe use of direct oral anticoagulants in patients with cirrhosis based on a systematic review of pharmacokinetic, pharmacodynamic and safety data. Eur J Clin Pharmacol 2024; 80 (06) 797-812
    CrossrefPubMedGoogle Scholar
  • 99 Guo W, Tian X, Qiu L, Li L. Direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver disease. J Am Coll Cardiol 2019; 74 (18) 2329-2330
    CrossrefPubMedGoogle Scholar
  • 100 Sasso R, Rockey DC. Anticoagulation therapy in patients with liver cirrhosis is associated with an increased risk of variceal hemorrhage. Am J Med 2019; 132 (06) 758-766
    CrossrefPubMedGoogle Scholar
  • 101 Leader A, Ten Cate V, Ten Cate-Hoek AJ. et al. Anticoagulation in thrombocytopenic patients with hematological malignancy: a multinational clinical vignette-based experiment. Eur J Intern Med 2020; 77: 86-96
    CrossrefPubMedGoogle Scholar
  • 102 Goel A, Zachariah U, Ramakrishna B, Elias E, Eapen CE. Baveno-VI clinical staging of cirrhosis under-estimates 5-year survival after variceal bleed in cryptogenic chronic liver disease patients in India. Eur J Gastroenterol Hepatol 2021; 33 (09) 1232-1234
    CrossrefPubMedGoogle Scholar
  • 103 Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65 (01) 310-335
    CrossrefPubMedGoogle Scholar
  • 104 Bianchini M, Cavani G, Bonaccorso A. et al. Low molecular weight heparin does not increase bleeding and mortality post-endoscopic variceal band ligation in cirrhotic patients. Liver Int 2018; 38 (07) 1253-1262
    CrossrefPubMedGoogle Scholar
  • 105 Ponthus S, Spahr L, Casini A. et al. Safety of variceal band ligation in patients with cirrhosis and portal vein thrombosis treated with anticoagulant therapy: a retrospective study. Eur J Gastroenterol Hepatol 2020; 32 (03) 395-400
    CrossrefPubMedGoogle Scholar
  • 106 Guillaume M, Christol C, Plessier A. et al. Bleeding risk of variceal band ligation in extrahepatic portal vein obstruction is not increased by oral anticoagulation. Eur J Gastroenterol Hepatol 2018; 30 (05) 563-568
    CrossrefPubMedGoogle Scholar
  • 107 Salem R, Vouche M, Baker T. et al. Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis. Transplantation 2015; 99 (11) 2347-2355
    CrossrefPubMedGoogle Scholar
  • 108 Thornburg B, Desai K, Hickey R. et al. Portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: technical considerations. Tech Vasc Interv Radiol 2016; 19 (01) 52-60
    CrossrefPubMedGoogle Scholar
  • 109 Chamarthy MR, Anderson ME, Pillai AK, Kalva SP. Thrombolysis and transjugular intrahepatic portosystemic shunt creation for acute and subacute portal vein thrombosis. Tech Vasc Interv Radiol 2016; 19 (01) 42-51
    CrossrefPubMedGoogle Scholar
  • 110 Rodrigues SG, Sixt S, Abraldes JG. et al. Systematic review with meta-analysis: portal vein recanalisation and transjugular intrahepatic portosystemic shunt for portal vein thrombosis. Aliment Pharmacol Ther 2019; 49 (01) 20-30
    CrossrefPubMedGoogle Scholar
  • 111 Wang Z, Jiang MS, Zhang HL. et al. Is post-TIPS anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology 2016; 279 (03) 943-951
    CrossrefPubMedGoogle Scholar
  • 112 Stine JG, Northup PG. Management of non-tumoral portal vein thrombosis in patients with cirrhosis. Dig Dis Sci 2019; 64 (03) 619-626
    CrossrefPubMedGoogle Scholar
  • 113 Cui SB, Shu RH, Yan SP. et al. Efficacy and safety of anticoagulation therapy with different doses of enoxaparin for portal vein thrombosis in cirrhotic patients with hepatitis B. Eur J Gastroenterol Hepatol 2015; 27 (08) 914-919
    CrossrefPubMedGoogle Scholar