{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:14:44Z","timestamp":1790694884591,"version":"4.1.0"},"reference-count":142,"publisher":"The Korean Association for the Study of the Liver","issue":"4","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272990"],"award-info":[{"award-number":["82272990"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["N_CUHK448\/23"],"award-info":[{"award-number":["N_CUHK448\/23"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CUHK direct research grant"}],"content-domain":{"domain":["e-cmh.org"],"crossmark-restriction":true},"short-container-title":["Clin Mol Hepatol"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:p>Portal vein thrombosis (PVT) is characterized by the formation of a thrombus (blood clot) within the portal vein system, including main portal vein and its intrahepatic portal vein branches, and may extend to the superior mesenteric vein or splenic vein. The emergence of PVT is linked to diverse risk factors, encompassing liver conditions with cirrhosis, abdominal infections, previous abdominal surgeries, malignancies, inherited or acquired thrombophilias, and systemic hypercoagulable conditions. Recent studies revealed a possible connection between the occurrence of PVT and either contracting corona virus disease 2019 (COVID-19) or receiving a COVID-19 vaccination. Current treatment strategies were primarily based on symptom management, extent, and progression of thrombosis, but their efficacy was inconsistent and suboptimal. Untimely or inadequate treatment can lead to the progression of the thrombus and increase the risk of complications, such as portal hypertension, variceal bleeding, and hepatic decompensation, posing a significant risk to the patient\u2019s life. Thus, early and appropriate initiation of pharmacologic and interventional treatments, as well as more aggressive strategies, is crucial for the management and prevention of PVT progression and recurrence. This review focuses on the literature on the recent advancements in the treatment of PVT using various therapeutic modalities, including anticoagulant therapy, thrombolysis, thrombectomy, interventional therapy and liver transplant in cirrhotic patients. In addition, we discuss pearls and pitfalls of these strategies for PVT, highlighting recent progress, identifying knowledge gaps, and proposing avenues towards precision management.<\/jats:p>","DOI":"10.3350\/cmh.2025.0411","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T02:50:24Z","timestamp":1750733424000},"page":"1139-1166","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Update in the treatment of cirrhotic patients with portal vein thrombosis"],"prefix":"10.3350","volume":"31","author":[{"given":"Jialin","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyang","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaibo","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuda","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoi Wing","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka Fai","family":"To","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4651-677X","authenticated-orcid":true,"given":"Wei","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1902","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2024.10.038"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27546"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2022.11.002"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(24)00155-9"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3834327"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000781"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.06.014"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1056\/nejmc2007575"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14601"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(21)00197-7"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-022-02732-3"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2104882"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa2104840"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2025.102553"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.09.003"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31646"},{"key":"ref17","first-page":"257","volume-title":"Application of percutaneous transluminal sharp recanalization in transjugular intrahepatic portosystemic shunt for patients with chronic portal vein occlusion","author":"Li","year":"2021"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.04.029"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.01.265"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.11.004"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.07.040"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-023-07993-3"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11216435"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15313"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.4103\/1319-3767.141687"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.452"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12112236"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/s1665-2681(19)31301-8"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.16263"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1069-8"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.04.042"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2004.042796"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2013.08.018"},{"key":"ref34","first-page":"1261A","volume-title":"Clinical outcome of portal vein thrombosis (PVT) in cirrhotic patients: observe or treat?: 1912","author":"Garcovich","year":"2011"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000002123"},{"key":"ref36","first-page":"126","volume-title":"Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients","author":"Ghabril","year":"2016"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1722260"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2014.12.002"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.20524\/aog.2020.0544"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-020-01550-4"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.02.023"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13942"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2024.01.096"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2024.101116"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1177\/10760296241301402"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2024.2307575"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1177\/10742484221145010"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2021.05.013"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-024-03322-8"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000228"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-023-03206-x"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-019-05572-z"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1177\/10760296221104797"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000001237"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.58739"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1177\/10760296241303758"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-015-4012-2"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12844"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13285"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12895"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-019-02035-0"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000001846"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.08.007"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001194"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-023-02960-8"},{"key":"ref66","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000002787"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1111\/apt.18474"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1093\/postmj\/qgaf062"},{"key":"ref69","volume-title":"Efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver cirrhosis","author":"Chou","year":"2024"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2021.07.039"},{"key":"ref71","first-page":"1026","volume-title":"Final study report of andexanet alfa for major bleeding with factor Xa inhibitors","author":"Milling","year":"2023"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2024.05.023"},{"key":"ref73","first-page":"e1","volume-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American college of cardiology\/American heart association joint committee on clinical practice guidelines","author":"Joglar","year":"2024"},{"key":"ref74","first-page":"1612","volume-title":"2021 European heart rhythm association practical guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation","author":"Steffel","year":"2021"},{"key":"ref75","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/978-3-031-08552-9","volume-title":"Baveno VII - Renewing consensus in portal hypertension","author":"de Franchis","year":"2022"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpth.2023.100052"},{"key":"ref77","doi-asserted-by":"publisher","DOI":"10.1097\/mog.0000000000001086"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1038\/s41395-018-0421-0"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13575"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15479"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1177\/15266028251325432"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i41.7470"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.1055\/a-1642-0990"},{"key":"ref84","doi-asserted-by":"publisher","DOI":"10.2478\/jtim-2023-0113"},{"key":"ref85","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.195.1.7892458"},{"key":"ref86","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.08.012"},{"key":"ref87","doi-asserted-by":"publisher","DOI":"10.3390\/life13061262"},{"key":"ref88","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20869"},{"key":"ref89","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02820.x"},{"key":"ref90","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-005-0090-4"},{"key":"ref91","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0b013e328338d995"},{"key":"ref92","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.06.029"},{"key":"ref93","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2010.07.028"},{"key":"ref94","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.228023"},{"key":"ref95","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2012.09.050"},{"key":"ref96","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-015-3777-1"},{"key":"ref97","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2014.12.012"},{"key":"ref98","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.15141252"},{"key":"ref99","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0000000000000729"},{"key":"ref100","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-014-0320-9"},{"key":"ref101","doi-asserted-by":"publisher","DOI":"10.1177\/0284185115595060"},{"key":"ref102","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2016.07.005"},{"key":"ref103","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12929"},{"key":"ref104","doi-asserted-by":"publisher","DOI":"10.1038\/srep33069"},{"key":"ref105","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2017.08.005"},{"key":"ref106","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-11455-y"},{"key":"ref107","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017162266"},{"key":"ref108","first-page":"2156","volume-title":"Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial","author":"Lv","year":"2018"},{"key":"ref109","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-018-5360-z"},{"key":"ref110","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000001097"},{"key":"ref111","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12702"},{"key":"ref112","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.737984"},{"key":"ref113","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2024.111316"},{"key":"ref114","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15044"},{"key":"ref115","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.01.029"},{"key":"ref116","doi-asserted-by":"publisher","DOI":"10.1111\/apt.70079"},{"key":"ref117","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32453"},{"key":"ref118","doi-asserted-by":"publisher","DOI":"10.1111\/apt.18509"},{"key":"ref119","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2023.10.013"},{"key":"ref120","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-023-10522-z"},{"key":"ref121","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.13035"},{"key":"ref122","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-320221"},{"key":"ref123","doi-asserted-by":"publisher","DOI":"10.1186\/s12920-024-01939-y"},{"key":"ref124","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.09.009"},{"key":"ref125","doi-asserted-by":"publisher","DOI":"10.1053\/j.tvir.2016.01.005"},{"key":"ref126","doi-asserted-by":"publisher","DOI":"10.1053\/tvir.2003.36433"},{"key":"ref127","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2024.102445"},{"key":"ref128","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25623"},{"key":"ref129","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2014.12.008"},{"key":"ref130","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000137104.38602.9f"},{"key":"ref131","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-1791247"},{"key":"ref132","first-page":"1145","volume-title":"Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review","author":"Rodr\u00edguez-Castro","year":"2012"},{"key":"ref133","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13353"},{"key":"ref134","first-page":"54","volume-title":"Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery","author":"Bala","year":"2022"},{"key":"ref135","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000041427"},{"key":"ref136","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-023-00505-8"},{"key":"ref137","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1997.d01-1083.x"},{"key":"ref138","doi-asserted-by":"publisher","DOI":"10.1177\/1457496920969084"},{"key":"ref139","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2014.36"},{"key":"ref140","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2024-334133"},{"key":"ref141","first-page":"e223163","volume-title":"Image-based vascular modeling for portal hypertension diagnosis","author":"Rold\u00e1n-Alzate","year":"2023"},{"key":"ref142","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2022.100563"}],"container-title":["Clinical and Molecular Hepatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-cmh.org\/upload\/pdf\/cmh-2025-0411.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-cmh.org\/journal\/view.php?doi=10.3350\/cmh.2025.0411","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-cmh.org\/upload\/pdf\/cmh-2025-0411.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T07:49:52Z","timestamp":1760600992000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-cmh.org\/journal\/view.php?doi=10.3350\/cmh.2025.0411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":142,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"URL":"https:\/\/doi.org\/10.3350\/cmh.2025.0411","relation":{},"ISSN":["2287-2728","2287-285X"],"issn-type":[{"value":"2287-2728","type":"print"},{"value":"2287-285X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"assertion":[{"value":"2025-04-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-24","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-01","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}