Department of Gastroenterology, "Grigore T Popa" University of Medicine and Pharmacy, Iași 700115, Romania.
World J Gastroenterol. 2018 Oct 21;24(39):4419-4427. doi: 10.3748/wjg.v24.i39.4419.
Portal vein thrombosis (PVT) is a frequent and serious complication in patients with liver cirrhosis (LC). Recently, a new classification of PVT was proposed, although the functional component was not completed included. The status of liver disease (compensated/decompensated) should be added to this classification. Reduced portal flow velocity and the acquired hypercoagulable status associated with LC are the main risk factors for PVT development, although endothelial dysfunction may play an important role that needs to be further evaluated. The European Association for the Study of the Liver and the American Association for the Study of Liver Disease recommend that the anticoagulant treatment should be consider in cirrhotic patients with PVT. Low molecular weight heparin and vitamin K antagonists proved their efficacy and relatively safety in PVT treatment, although in addition to recanalization rates, more complex end-points such as mortality and decompensation rate should be evaluated. The new oral anticoagulant therapies offers the advantage of oral administration in the absence of laboratory monitoring, however, there are a few reports regarding their use in cirrhotic patients, most of them referring to compensated isolated cases. Transjugular intrahepatic portosystemic shunt could be an alternative if thrombosis progresses despite anticoagulatant therapy and/or when PVT is associated with portal hypertension complications. The aim of this editorial is to discuss the different aspects of pathophysiology, clinical relevance, diagnosis and management of PVT in patients with LC.
门静脉血栓形成（PVT）是肝硬化（LC）患者常见且严重的并发症。最近，提出了一种新的 PVT 分类，尽管尚未包括功能成分。应该在该分类中添加肝病的状态（代偿/失代偿）。门静脉血流速度降低和与 LC 相关的获得性高凝状态是 PVT 发展的主要危险因素，尽管内皮功能障碍可能发挥重要作用，但需要进一步评估。欧洲肝脏研究协会和美国肝脏研究协会建议对患有 PVT 的肝硬化患者进行抗凝治疗。低分子肝素和维生素 K 拮抗剂已证明其在 PVT 治疗中的疗效和相对安全性，尽管除了再通率外，还应评估更复杂的终点，如死亡率和失代偿率。新型口服抗凝治疗具有无需实验室监测即可口服给药的优势，然而，关于其在肝硬化患者中的应用仅有少数报道，其中大多数涉及代偿性孤立病例。如果尽管抗凝治疗和/或 PVT 伴有门脉高压并发症仍进展，经颈静脉肝内门体分流术可能是一种替代方法。本社论旨在讨论 LC 患者 PVT 的病理生理学、临床相关性、诊断和管理的不同方面。
