PORTAL VEIN THROMBOSIS IN CIRRHOTICS: NOVEL INSIGHTS
Dr Zeeshan Ahmad Wani, *Dr Afaq Ahmad Khan, Dr Sonmoon Mohapatra, Dr Tufeel Kochak,
Rakhi Gupta and Ajeet Singh Bhadoria
ABSTRACT
Among all thrombotic complications, portal vein thrombosis (PVT) is the most common thrombotic condition in cirrhotic patients and is encountered in 10-25% of cirrhotics. Pathophysiologically, cirrhosis is not considered a hypocoagulable state, rather various clinical studies support it as having a thrombotic potential. Risk factors for thrombosis include inherited and acquired deficiency of factors involved in anticoagulation, venous stasis of portal vein and local factors related to endothelium. PVT in cirrhotics may manifest as asymptomatic condition to life threatening complications e.g variceal bleed and gut infarction. Anticoagulation therapy forms important strategy in patients of cirrhosis with PVT, although robust guidelines dictating such issues are lacking. LMW Heparin and vitamin K antagonists are being successfully used to treat PVT in cirrhosis but still a proper drug regimen and monitoring is incompletely explored area. Use of direct thrombin inhibitors and Xa inhibitors has its own limitation in liver disease patients. New group of patients like Non Alcoholic fatty liver disease (NAFLD) related cirrhosis have high risk of PVT. Further what is the risk of PVT in non cirrhotic NAFLD patients is yet not fully studied especially in patients with metabolic syndrome and insulin resistance. Is it a true fact that a third front of adult idiopathic PVT is based on endothelial dysfunction related to metabolic syndrome contrasting western occult MPD as etiology v/s childhood Asian infectious and immune etiology of PVT/EHPVO. Thrombectomy and TIPS may be considered as second line options after anticoagulation. Further appealed MELD scores are still not an option for advanced PVT in cirrhotic patients while considering them for liver transplant. In this review we address useful information regarding the new insights in terms of etiopathogenesis, mechanisms and management of PVT in cirrhotic patients.
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