Wu Matthew, Schuster Michael, Tadros Micheal
Albany Medical College, Albany, NY, USA.
Department of Radiology, Albany Medical Center Hospital, Albany, NY, USA.
J Clin Transl Hepatol. 2019 Jun 28;7(2):154-164. doi: 10.14218/JCTH.2018.00057.
The clinical management of portal vein thrombosis (PVT) remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. The natural history and clinical outcome of PVT are highly variable, dependent upon size, extent and degree of the thrombotic occlusion, as well as the physiological impact of patient comorbidities. While existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT, management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis, factoring in the state of underlying liver disease. In general, patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer management. However, existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying cancer. While low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT, an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in PVT. As such, direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.
门静脉血栓形成（PVT）的临床表现具有异质性，且与肝脏疾病、恶性肿瘤和高凝状态相关，因此其临床管理仍不明确。PVT的自然病程和临床结局差异很大，取决于血栓闭塞的大小、范围和程度，以及患者合并症的生理影响。虽然现有临床指南一致推荐对有症状的急性PVT肝硬化患者使用低分子量肝素或维生素K拮抗剂进行抗凝治疗，但无症状和慢性PVT的管理可能需要根据具体情况确定，同时考虑潜在肝脏疾病的状况。一般来说，患有PVT和潜在恶性肿瘤的患者应进行抗凝治疗，以缓解症状并预防可能干扰癌症治疗的复发。然而，现有临床数据不支持对无潜在癌症的无症状PVT肝硬化患者进行常规抗凝治疗。虽然低分子量肝素和维生素K拮抗剂仍然是PVT最常用的药物，但新出现的临床证据表明，直接口服抗凝剂在PVT中可能安全有效。因此，直接口服抗凝剂可能为未来PVT管理提供更方便的抗凝选择。
