Portal vein thrombosis: diagnosis, management, and endpoints for future clinical studies

Laure Elkrief; Virginia Hernandez-Gea; Marco Senzolo; Agustin Albillos; Anna Baiges; Annalisa Berzigotti; Christophe Bureau; Sarwa Darwish Murad; Andrea De Gottardi; François Durand; Juan-Carlos Garcia-Pagan; Ton Lisman; Mattias Mandorfer; Valérie McLin; Lucile Moga; Filipe Nery; Patrick Northup; Alexandre Nuzzo; Valérie Paradis; David Patch; Audrey Payancé; Vincent Plaforet; Aurélie Plessier; Johanne Poisson; Lara Roberts; Riad Salem; Shiv Sarin; Akash Shukla; Christian Toso; Dhiraj Tripathi; Dominique Valla; Maxime Ronot; Pierre-Emmanuel Rautou; ERN RARE-LIVER and VALDIG, an EASL consortium

doi:10.1016/S2468-1253(24)00155-9

Portal vein thrombosis: diagnosis, management, and endpoints for future clinical studies

Lancet Gastroenterol Hepatol. 2024 Sep;9(9):859-883. doi: 10.1016/S2468-1253(24)00155-9. Epub 2024 Jul 9.

Authors

Laure Elkrief¹, Virginia Hernandez-Gea², Marco Senzolo³, Agustin Albillos⁴, Anna Baiges², Annalisa Berzigotti⁵, Christophe Bureau⁶, Sarwa Darwish Murad⁷, Andrea De Gottardi⁸, François Durand⁹, Juan-Carlos Garcia-Pagan², Ton Lisman¹⁰, Mattias Mandorfer¹¹, Valérie McLin¹², Lucile Moga⁹, Filipe Nery¹³, Patrick Northup¹⁴, Alexandre Nuzzo¹⁵, Valérie Paradis¹⁶, David Patch¹⁷, Audrey Payancé⁹, Vincent Plaforet¹⁸, Aurélie Plessier⁹, Johanne Poisson¹⁹, Lara Roberts²⁰, Riad Salem²¹, Shiv Sarin²², Akash Shukla²³, Christian Toso²⁴, Dhiraj Tripathi²⁵, Dominique Valla⁹, Maxime Ronot²⁶, Pierre-Emmanuel Rautou²⁷; ERN RARE-LIVER and VALDIG, an EASL consortium

Affiliations

¹ Faculté de médecine de Tours, et service d'hépato-gastroentérologie, Le Centre Hospitalier Régional Universitaire de Tours, Tours, France; Centre de recherche sur l'inflammation, Université Paris-Cité, Paris, France.
² Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic de Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Departament de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
³ Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
⁴ Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain; Departamento de Gastroenterología y Hepatología, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramon y Cajal, Madrid, Spain.
⁵ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
⁶ Service d'Hépatologie Hôpital Rangueil, Université Paul Sabatier, Toulouse, France.
⁷ Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
⁸ Gastroenterology and Hepatology Department, Ente Ospedaliero Cantonale Faculty of Biomedical Sciences of Università della Svizzera Italiana, Lugano, Switzerland.
⁹ Centre de recherche sur l'inflammation, Université Paris-Cité, Paris, France; Service d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France.
¹⁰ Department of Surgery, University Medical Center Groningen, Groningen, Netherlands.
¹¹ Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
¹² Swiss Pediatric Liver Center, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
¹³ Immuno-Physiology and Pharmacology Department, School of Medicine and Biomedical Sciences, University of Porto, Portugal.
¹⁴ Transplant Institute and Division of Gastroenterology, NYU Langone, New York, NY, USA.
¹⁵ Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, AP-HP Hôpital Beaujon, Clichy, France; Laboratory for Vascular and Translational Science, INSERM UMR 1148, Paris, France.
¹⁶ Department of Pathology, AP-HP Hôpital Beaujon, Clichy, France.
¹⁷ Department of Hepatology and Liver Transplantation, Royal Free Hospital, London, UK.
¹⁸ Service de Radiologie, AP-HP Hôpital Beaujon, Clichy, France.
¹⁹ Centre de recherche sur l'inflammation, Université Paris-Cité, Paris, France; Service de Gériatrie, Hôpital Corentin Celton (AP-HP), Paris, France.
²⁰ Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
²¹ Northwestern Memorial Hospital, Northwestern University, Chicago, IL, USA.
²² Institute of Liver and Biliary Sciences, New Delhi, India.
²³ Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India.
²⁴ Service de Chirurgie Viscérale, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
²⁵ Department of Liver and Hepato-Pancreato-Biliary Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
²⁶ Centre de recherche sur l'inflammation, Université Paris-Cité, Paris, France; Service de Radiologie, AP-HP Hôpital Beaujon, Clichy, France.
²⁷ Centre de recherche sur l'inflammation, Université Paris-Cité, Paris, France; Service d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France. Electronic address: [email protected].

PMID: 38996577
DOI: 10.1016/S2468-1253(24)00155-9

Abstract

Portal vein thrombosis (PVT) refers to the development of a non-malignant obstruction of the portal vein, its branches, its radicles, or a combination. This Review first provides a comprehensive overview of all aspects of PVT, namely the specifics of the portal venous system, the risk factors for PVT, the pathophysiology of portal hypertension in PVT, the interest in non-invasive tests, as well as therapeutic approaches including the effect of treating risk factors for PVT or cause of cirrhosis, anticoagulation, portal vein recanalisation by interventional radiology, and prevention and management of variceal bleeding in patients with PVT. Specific issues are also addressed including portal cholangiopathy, mesenteric ischaemia and intestinal necrosis, quality of life, fertility, contraception and pregnancy, and PVT in children. This Review will then present endpoints for future clinical studies in PVT, both in patients with and without cirrhosis, agreed by a large panel of experts through a Delphi consensus process. These endpoints include classification of portal vein thrombus extension, classification of PVT evolution, timing of assessment of PVT, and global endpoints for studies on PVT including clinical outcomes. These endpoints will help homogenise studies on PVT and thus facilitate reporting, comparison between studies, and validation of future studies and trials on PVT.

Publication types

Review

MeSH terms

Anticoagulants / therapeutic use
Female
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / therapy
Humans
Hypertension, Portal / complications
Hypertension, Portal / diagnosis
Hypertension, Portal / etiology
Hypertension, Portal / therapy
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Portal Vein*
Pregnancy
Quality of Life
Risk Factors
Venous Thrombosis* / diagnosis
Venous Thrombosis* / therapy

Substances

Anticoagulants