Key Takeaways

In a patient with new portal vein thrombosis (PVT), it is important to determine whether they have underlying chronic liver disease, because the evaluation, prognosis, and treatment differ between cirrhotic and non-cirrhotic PVT.

Imaging modalities for diagnosing PVT include Doppler ultrasound, CTA and MRI.

Important considerations with imaging include clot burden, degree of obstruction, clot location and time course of clot formation (acute vs. chronic). It is also important to rule out hepatocellular carcinoma (HCC).

In patients with non-cirrhotic PVT, diagnostic tests should be performed to rule out hereditary thrombophilia, antiphospholipid antibody syndrome, myeloproliferative neoplasm and paroxysmal nocturnal hemoglobinuria.

Patients with non-cirrhotic PVT should receive anticoagulation, typically heparin followed by warfarin or DOAC.

Treatment is aimed at preventing propagation of the thrombus into the mesenteric vein, which may cause intestinal ischemia and at promoting recanalization achieve recanalization to prevent development of portal hypertension.

There is no evidence to guide how long to treat with anticoagulation but guidelines recommend at least 6 months.

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