Management of portal vein thrombosis in light of current EASL recommendations

Czech version

Authors: V. Křížová ¹; B. Pospíšilová ¹; I. Mikoviny Kajzrlíková ¹; P. Vítek ^1,2
Authors‘ workplace: Interní oddělení, Moravskoslezská nemocnice Frýdek-Místek, p. o. ¹; Lékařská fakulta OU, Ostrava ²
Published in: Gastroent Hepatol 2026; 80(5): 409-415
Category: Hepatology: Best Practises
doi: https://doi.org/10.48095/ccgh2026409

Overview

Portal vein thrombosis (PVT) is among the most common thromboses of the splanchnic venous system, yet this diagnosis is still rarely encountered. It is seen more frequently in patients with liver cirrhosis, in whom it is considered a consequence of the natural progression of liver disease rather than a complication. However, it also affects patients without pre-existing liver disease. Etiology in the absence of liver cirrhosis is diverse and should always be investigated, as the etiological factor of PVT often influences both the choice and duration of anticoagulant therapy. The clinical presentation of PVT varies according to the extent of portal vein involvement, ranging from asymptomatic findings on imaging studies to acute severe conditions with the development of clinically significant portal hypertension or the feared complication of intestinal infarction in patients with concurrent involvement of the superior mesenteric vein. In addition to the established low-molecular-weight heparins and vitamin K antagonists, direct oral anticoagulants (DOACs) are increasingly used in treatment, along with radiological interventions aimed at recanalization of the portal vein and management of portal hypertension. Anticoagulant therapy often presents physicians with a dilemma regarding anticoagulation in patients following often dramatic upper gastrointestinal bleeding caused by portal hypertension, and decisions about treatment duration are frequently problematic as well. Correct diagnostic and therapeutic management is guided by current recommendations developed by the European Association for the Study of the Liver (EASL), published in November 2025, as referred to by this article.

Keywords:

management – Anticoagulant therapy – acute portal vein thrombosis – chronic portal vein thrombosis – portal cavernoma

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