Tratamento da Trombose Aguda da Veia Porta em TVP Recente Sem Cirrose Subjacente
Cenário Clínico
Este protocolo aplica-se a pacientes com trombose recente da veia porta na ausência de cirrose. O reconhecimento precoce e a intervenção imediata são essenciais para proteger a viabilidade intestinal e restaurar o fluxo venoso portal adequado.
Abordagem Terapêutica
A base do tratamento neste contexto é a terapia anticoagulante. Os agentes específicos, a sequência e a duração estão definidos no protocolo completo — o regime completo não é resumido aqui.
Objetivos Clínicos
- Recanalização da veia porta
- Ausência de isquemia intestinal (sem necrose intestinal)
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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