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  • Title: Impact of anticoagulation on outcomes in acute non-cirrhotic and non- malignant portal vein thrombosis: a retrospective observational study.
    Author: Hall TC, Garcea G, Metcalfe M, Bilk D, Rajesh A, Dennison A.
    Journal: Hepatogastroenterology; 2013; 60(122):311-7. PubMed ID: 23858545.
    Abstract:
    BACKGROUND/AIMS: No definitive evidence exists regarding the treatment of acute portal vein thrombosis (PVT). Treatment modalities that have been employed and investigated include conservative management, anticoagulation, thrombolysis and thrombectomy. This observational study examines the impact of anticoagulation on PVT. METHODOLOGY: The electronic radiology database was searched with keywords 'portal vein' and 'thrombosis'. Relevant patient notes and imaging were reviewed to collect data from those with acute PVT. The primary end point was portal vein recanalisation. Secondary outcome measures were morbidity and the development of portal hypertension and its sequelae (including variceal bleeding). Data from patients with PVT in the context of cirrhosis, malignancy or liver transplant were excluded. RESULTS: Partial or complete recanalization of the portal vein occurred in 81.8% of anticoagulated patients and 37.5% of the non-treatment group. Five patients died, 1 following an intracranial haemorrhage whilst anticoagulated and another who was not treated and developed secondary small bowel ischaemia and peritonitis. The remaining 3 died from their underlying pathology. Late complications, such as varices and ascites occurred more frequently in the patients in whom the portal vein failed to recanalize (83.3% vs. 27.3%). CONCLUSIONS: Spontaneous resolution of acute portal vein thrombosis is uncommon. Early anticoagulation results in a higher rate of recanalisation with minimal associated morbidity when compared with no treatment.
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