Treatment of Acute Portal Vein Thrombosis in Recent PVT Without Underlying Cirrhosis
Clinical Scenario
This protocol applies to patients with recent portal vein thrombosis in the absence of cirrhosis. Prompt recognition and early intervention are essential to protect bowel viability and restore adequate portal venous flow.
Treatment Approach
The cornerstone of management in this setting is anticoagulation therapy. The specific agents, sequencing, and duration are defined in the full protocol — the complete regimen is not summarised here.
Clinical Goals
- Portal vein recanalisation
- Absence of intestinal ischaemia (no bowel necrosis)
References
DOI: 10.1016/j.jhep.2025.08.001
- Anticoagulation initiated as soon as possible is the first-line therapy for recent PVT in the absence of cirrhosis.
- Anticoagulation should be initiated as soon as possible, since early initiation of anticoagulation may reduce the risk of developing intestinal ischaemia and increases the probability of portal vein recanalisation.
- Anticoagulation should be continued for at least 6 months.
- Anticoagulation initiated as soon as possible is the treatment of choice.
- In patients with recent PVT without cirrhosis, direct oral anticoagulants are suggested as an alternative to low-molecular-weight heparin and/or vitamin K antagonists, during the first 6 months after PVT diagnosis, to reduce morbidity and mortality.
- In patients with recent PVT, there are two main goals of anticoagulant treatment: (i) to prevent bowel necrosis requiring bowel resection and (ii) to achieve sufficient recanalisation of the portal venous system to prevent the future development of portal hypertension and its complications.
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