Incidence and Outcomes of Portal Vein Thrombosis in Cirrhosis

Routine screening for hepatocellular carcinoma (HCC) in patients with cirrhosis results in identification of incidental portal vein thrombosis (PVT) in an estimated 0.6% to 26% of patients. Risk factors for PVT in this population and its consequences are unclear.

In a preplanned ancillary study of a multicenter, prospective, randomized trial, investigators assessed the cumulative incidence of PVT in 1243 patients with cirrhosis (Child-Pugh class A or B). Clinical data were collected during routine follow-up visits, and Factor V Leiden and G20210A prothrombin gene mutations were assessed using stored sera available for most patients. The development of PVT was confirmed with dynamic imaging. Thrombi considered to be related to HCC were excluded. Decompensation and liver disease progression were defined a priori and included clinical and laboratory indicators of progression.

Mean follow-up was 47 months. The 1-year, 3-year, and 5-year cumulative incidences of PVT were 4.6%, 8.2%, and 10.7%, respectively. Most PVT was partial and nonocclusive. In multivariate analysis, risk factors for PVT were baseline esophageal varices (P=0.03) and prothrombin time (P=0.004) but not prothrombotic mutations or liver disease progression. Furthermore, once PVT developed, it was not independently associated with disease progression.