Treatment of portal vein thrombosis in cirrhosis with anticoagulation-more than meets the eye?

Portal vein thrombosis(PVT)is a common complication in patients with advanced chronic liver disease(i.e.,cirrhosis).In contrast to other thrombotic diseases,PVT in patients with cirrhosis is frequently asymptomatic and discovered incidentally during routine imaging procedures.There is ongoing debate on whether all patients with PVT require treatment as it is unclear whether PVT is a relatively innocent bystander or whether PVT worsens disease progression(1).Treatment may be required in patients with>50%occlusion of the portal vein who are transplant candidates to avoid thrombosis progression that may hinder a future liver transplantation or cause progression of portal hypertension(2).Current treatment consists of therapeutic anticoagulation with vitamin K antagonists,heparins,or direct oral anticoagulants.Although anticoagulant therapy for cirrhotic PVT is relatively safe,the efficacy is modest,with meta-analyses demonstrating recanalization of the portal vein in~30-40%of patients without anticoagulation,and~60-70%with anticoagulation(3,4).