What are indications for anticoagulation in a patient with chronic liver disease/cirrhosis and portal vein thrombosis?

By William Aird

If cirrhosis is decompensated, consider anticoagulation in patients who are candidates for liver transplantation, those with symptoms, and those in whom the thrombus extends into the superior mesenteric vein leading to suspected intestinal ischemia.

If cirrhosis is compensated, anticoagulation is recommended (though the decision should be individualized). Anticoagulation is for at least 6 months. Before starting anticoagulation, consider screening for varices. Acute development of portal vein thrombosis favors anticoagulation therapy.

Am J Gastroenterol. 2020;115:18-40

Guideline recommendations

2020 ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation:

Approach to management of portal vein thrombosis.

2020 Practice Guidance by the American Association for the Study of Liver Diseases: