Treatment • The Blood Project

What would you recommend for this patient?

a

Watch and wait

b

Thrombolytic therapy

c

Heparin

d

Aspirin

e

TIPS

Do we worry about embolization of portal vein thrombus to the lung?

a

Yes

b

No

So, if there is no concern about embolization to the lung, what it is the big deal with portal vein thrombosis?

a

It can cause liquefaction of the liver

b

It can extend proximally into the mesenteric vein, causing intestinal ischemia

c

It can transition into local malignancy

d

It can obliterate the portal vein and lead to portal hypertension with variceal bleeding

What are two important goals of therapy?

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1) Prevent intestinal ischemia from thrombus extension to mesenteric veins
2) Promote recanalization to prevent portal hypertension and variceal bleeding

There is no evidence to guide duration of
anticoagulation.

British Journal of Haematology, 2012, 159, 28–38

Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice
Guidance by the American Association for the Study of Liver Diseases

How does this management differ from that of PVT in the setting of cirrhosis?

a

In cirrhosis-related PVT, anticoagulation is never indicated

b

In cirrhosis-related PVT, anticoagulation is not always indicated

c

In cirrhosis-related PVT, all patients should receive anticoagulation, but for a longer period of time

d

In cirrhosis-related PVT, TIPS is routinely recommended

ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation

The patient was admitted to the Medicine service. She was started on unfractionated heparin and then bridged to coumadin with an INR goal of 2-3. She was discharged three days after admission and was scheduled to be followed up by outpatient hematology.