Portal vein thrombosis natural history, complications and prognosis

If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or esophageal varices/bleeding, hepatic encephalopathy, splenomegaly, portal biliopathy, and cholangiopathy. Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.

• There is usually subclinical prothrombotic state in about in about 72% of idiopathic portal vein thrombosis.
• If left untreated, patients with portal vein thrombosis may progress to develop portal cavernoma, gastric or esophageal varices/bleeding, hepatic encephalopathy, splenomegaly, portal biliopathy, and cholangiopathy.^[1]

• Common complications of portal vein thrombosis include:^{[2][3][4][5][6]}
  • Portal cavernoma
  • Gastric or esophageal varices/bleeding
  • Hepatic encephalopathy
  • Portal biliopathy or cholangiopathy
  • Thrombocytopenia
  • Splenomegaly
  • Ascites
  • Peritonitis
  • Hypoxia
  • Pulmonary artery hypertension
  • Portal hypertensive gastropathy

• The 1 year mortality rate of patients with chronic portal vein thrombosis is approximately 80%-95% and the 3 year mortality rate of patients with chronic portal vein thrombosis is approximately 75%-90%.^[7][8][9]
• Mortality in patients with cancer or cirrhosis in one year is 26% and those without cancer or cirrhosis is 8%.^[3]
• Depending on the extent of the model for end-stage liver disease score at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.^[10]
• Morbidity and mortality is associated with following factors:^[7]
  • Increasing age
  • Recurrent thrombosis
  • Portal cholangiopathy
  • Progression of the underlying myeloproliferative disease or its transformation into acute leukemia

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