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Portal vein thrombosis (PVT) among patients with cirrhosis is associated with early mortality. Management is challenging and differs based on chronicity and extent of the thrombosis and the balance of benefits and harms of anticoagulation.
Asymptomatic patients with compensated cirrhosis should not be screened for PVT; but when PVT is discovered incidentally on imaging, clinicians should determine clot extent, degree of lumen occlusion, and chronicity, and assess for possible malignancy.
If anticoagulation is planned, endoscopic variceal screening is warranted, including band ligation if the patient is not receiving nonselective β-blocker prophylaxis. Delays …