Korean J Gastroenterol.  2021 Sep;78(3):177-182. 10.4166/kjg.2021.050.

The Effect of Anticoagulant in Patients with Cirrhosis Associated with Acute Portal Vein Thrombosis

• Jo HG
• Kim YR
• Cho EY

• KMID: 2520359
• DOI: http://doi.org/10.4166/kjg.2021.050

Abstract

The treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis (LC) has been controversial, and it is generally caseand institution-dependent. The occurrence of acute or extensive PVT is critical and requires urgent treatment because it is usually accompanied by symptoms, particularly when total occlusion occurs, causing acute decompensation of liver disease. Even in severe cases, drug selection and treatment duration are determined based on each institution’s experience. Therefore, consistent guidelines for the treatment of patients with LC with PVT are required. Recently, a patient with acute occlusive PVT with LC who showed signs of acute decompensation was treated by administering low molecular weight heparin as anticoagulant therapy. After anticoagulant treatment, the portal vein was almost completely recanalized, and the deteriorated liver function improved. In addition, the patient recovered well and showed no recurrence of PVT for more than a year. Thus, the most recent knowledge regarding the treatment of nonmalignant PVT in LC was reviewed along with a case report.

Keyword

Liver cirrhosis; Portal vein; Venous thrombosis; Anticoagulants

Figure

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  Fig. 1 Pre-treatment axial view of abdominal computed tomography (CT) images. (A, B) At admission, the axial portal phase CT image showed an occluded right and main portal vein (arrow of A, right portal vein; arrowhead of A, main portal vein). In addition, the precontrast CT image showed a newly developed hyperdense thrombosis in the right portal vein compared to the main portal vein (arrow of B, 58 HU indicated acute thrombus; arrowhead of B, 27 HU indicated chronic thrombus). (C, D) Seven days before admission, axial portal phase CT image showed partial thrombosis in the right portal vein (arrow of C). This thrombosis showed low density in the precontrast image (arrow of D, 27 HU). HU, housefield unit.

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  Fig. 2 Post-treatment ultrasonography (US) and axial view of abdominal computed tomography (CT) images. (A) After 2 weeks of anticoagulant therapy, the US image showed no flow signal at the right proximal portal vein using super microvascular imaging (SMI) (arrow). (B) After 3 weeks of anticoagulant therapy, the US image showed a restored portal vein flow signal on SMI (arrow). (C) After 1 month of anticoagulant therapy, the axial portal phase CT image showed recanalization of the right portal vein (arrow), but remaining preexisting chronic thrombus. (D) At 6 months after the end of anticoagulant therapy, the axial portal phase CT image showed improvements of partial thrombosis (arrow), recanalized left portal vein (dotted arrow), and decreased ascites. (E) At 6 months after the end of anticoagulation therapy, axial portal phase CT image showed cavernous transformation (arrow).

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  Fig. 3 Changes in the laboratory findings during anticoagulant therapy. LMWH (enoxaparin) was administered for 1 month, starting with HD 4 (2020-02-14) (red arrow). LMWH, low molecular weight heparin; PT, prothrombin time; INR, international normalized ratio; HD, hospital day; CRP, C-reactive protein.

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