Highlights
- •This is the first systematic review and meta-analysis on the prevalence and incidence of portal vein thrombosis (PVT) in liver cirrhosis.
- •In this systematic review and meta-analysis, the target population does not include patients with hepatocellular carcinoma or abdominal surgery.
- •Approximately one seventh of cirrhotic patients have PVT, and one tenth will develop PVT.
- •Progression of liver cirrhosis and portal hypertension seems to be in parallel with risk of PVT.
Abstract
Background
Portal vein thrombosis (PVT) may be associated with negative outcomes in patients
with liver cirrhosis. However, the prevalence and incidence of PVT in liver cirrhosis
are heterogeneous among studies and have not been sufficiently determined yet.
Methods
The PubMed, EMBASE, and Cochrane Library databases were searched. Eligible studies
would explore the prevalence and/or incidence of PVT in liver cirrhosis without hepatocellular
carcinoma or abdominal surgery. Pooled proportion with 95% confidence interval (CI)
was calculated using a random-effect model. Factors associated with the presence/occurrence
of PVT were also extracted.
Results
Among the 8549 papers initially identified, 74 were included. Fifty-four studies explored
the prevalence of PVT in liver cirrhosis with a pooled prevalence of 13.92% (95%CI=11.18–16.91%).
Based on cross-sectional data, Child-Pugh class B/C, higher D-dimer, ascites, and
use of non-selective beta-blockers (NSBBs) were associated with the presence of PVT
in liver cirrhosis. Twenty-three studies explored the incidence of PVT in liver cirrhosis
with a pooled incidence of 10.42% (95%CI=8.16–12.92%). Based on cohort data, Child-Pugh
class B/C, higher model of end-stage liver disease score, higher D-dimer, lower platelets
count, decreased portal flow velocity, ascites, use of NSBBs, and moderate or high-risk
esophageal varices could predict the occurrence of PVT in liver cirrhosis.
Conclusion
Approximately one seventh of cirrhotic patients have PVT, and one tenth will develop
PVT. Progression of liver cirrhosis and portal hypertension seems to be in parallel
with the risk of PVT. Prospective studies with detailed information about classification
and extension of PVT in liver cirrhosis are needed.
Graphical abstract
Graphical Abstract
Keywords
List of abbreviations in the order of appearance:
PVT (portal vein thrombosis), LT (liver transplantation), HCC (hepatocellular carcinoma), CT (computed tomography), MRI (magnetic resonance imaging), PRISMA (preferred reporting items for systematic reviews and meta-analyses), MELD (model of end-stage liver disease), INR (international normalized ratio), NSBBs (non-selective beta-blockers), JBI (Joanna Briggs Institute Critical Appraisal), OR (odds ratio), WMD (weighted mean difference), CI (confidence interval)To read this article in full you will need to make a payment
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References
- Burden of liver diseases in the world.J Hepatol. 2019; 70: 151-171
- The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet Gastroenterol Hepatol. 2020; 5: 245-266
- Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.J Hepatol. 2006; 44: 217-231
- Portal vein thrombosis prevalence and associated mortality in cirrhosis in a nationally representative inpatient cohort.J Gastroenterol Hepatol. 2019; 34: 1088-1092
- Portal vein thrombosis.Clin Liver Dis. 2015; 19: 199-221
- Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long-term outcomes after liver transplantation.Int J Clin Pract. 2019; 73
- Helicobacter pylori as an Initiating factor of complications in patients with cirrhosis: a single-center observational study.Front Med (Lausanne). 2020; 7: 96
- Predicting the risk of portal vein thrombosis in patients with liver cirrhosis and hepatocellular carcinoma.Heliyon. 2020; 6: e04677
- Nonselective beta-blockers and the risk of portal vein thrombosis in patients with cirrhosis: results of a prospective longitudinal study.Aliment Pharmacol Ther. 2019; 49: 582-588
- Natural history of patients with non cirrhotic portal hypertension: comparison with patients with compensated cirrhosis.Dig Liver Dis. 2018; 50: 839-844
- Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: a prospective study.Liver Int. 2019; 39: 1459-1467
- Thromboelastometry hypercoagulable profiles and portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma.Dig Liver Dis. 2017; 49: 440-445
- Splanchnic vein thrombosis in liver cirrhosis after splenectomy or splenic artery embolization: a systematic review and meta-analysis.Adv Ther. 2021; 38: 1904-1930
- Prevalence and clinical significance of portal vein thrombosis in patients with cirrhosis and acute decompensation.Clin Gastroenterol Hepatol. 2020; 18 (e1): 2564-2572
- Nontumorous portal vein thrombosis in liver cirrhosis: possible role of β-blockers.Med Princ Pract. 2018; 27: 466-471
- Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study.Hepatology. 2015; 61: 660-667
- Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis.Gastroenterology. 2019; 156: 1582-1599
- Systematic review: portal vein thrombosis in cirrhosis.Aliment Pharmacol Ther. 2010; 31: 366-374
- Portal vein thrombosis: What is new?.Ann Hepatol. 2015; 14: 20-27
- Nontumoral portal vein thrombosis: a challenging consequence of liver cirrhosis.J Clin Transl Hepatol. 2020; 8: 432-444
- Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.JBI Evid Synth. 2020; 18: 2127-2133
- Protein S for portal vein thrombosis in cirrhotic patients waiting for liver transplantation.J Clin Med. 2020; 9: 1181
- Elevated international normalized ratio: a risk factor for portal vein thrombosis in cirrhotic patients.Gastroenterology Res. 2019; 12: 135-140
- Risk factors and mortality in cirrhotic portal vein thrombosis-a single centre study.J Gastroenterol Hepatol. 2019; 34: 166
- Risk factors and impact of portal vein thrombosis in liver transplantation.Rev Esp Enferm Dig. 2019; 111: 437-444
- Systemic inflammation and portal vein thrombosis in cirrhotic patients with gastroesophageal varices.European J Gastroenterol Hepatol. 2019; 32: 401-405
- Visceral fat is associated with cirrhotic portal vein thrombosis.Expert Rev Gastroenterol Hepatol. 2019; 13: 1017-1022
- Influence of spontaneous splenorenal shunts on clinical outcomes in decompensated cirrhosis and after liver transplantation.Hepatol Commun. 2018; 2: 437-444
- Clinical profile of patients with portal vein thrombosis and cirrhosis of liver-a study in a tertiary centre of South India.J Clin Experimental Hepatol. 2018; 8: S66
- Portal vein thrombosis in adult patients with cirrhosis: outcomes of liver transplantation.Transplantation. 2018; 102: 266-267
- Prevalence of portal trombosis related to the degree of portal hypertension.J Hepatol Conference. 2017; 66: S128-S1S9
- Portal vein thrombosis in cirrhosis is not associated with intestinal barrier disruption or increased platelet aggregability.Clin Res Hepatol Gastroenterol. 2016; 40: 722-729
- Portal vein thrombosis relevance on liver cirrhosis: Italian venous thrombotic events registry.Intern Emerg Med. 2016; 11: 1059-1066
- Hyperhomocysteinemia and MTHFR C677T polymorphism in patients with portal vein thrombosis complicating liver cirrhosis.Thromb Res. 2016; 141: 189-195
- Splenectomy causes 10-fold increased risk of portal venous system thrombosis in liver cirrhosis patients.Med Sci Monit. 2016; 22: 2528-2550
- Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients.Hepatobiliary Pancreat Dis Int. 2016; 15: 499-503
- Portal vein thrombosis in patients with cirrhosis: just a common finding or a predictor of poor outcome?.Ann Hepatol. 2016; 15: 902-906
- Risk factors for nontumoral portal vein thrombosis in patients with liver cirrhosis.World Chin J Digestol. 2015; 23: 2886-2893
- Procoagulant imbalance aggravated with falling liver function reserve, but not associated with the presence of portal vein thrombosis in cirrhosis.Eur J Gastroenterol Hepatol. 2015; 27: 672-678
- Study on portal vein thrombosis in cirrhotic patients.J Clin Exp Hepatol. 2015; 5: S37
- Study on the clinical profile of portal vein thrombosis in patients of alcoholic cirrhosis.Indian J Gastroenterol. 2015; 34: A39-A40
- PAI-1 4G-4G and MTHFR 677TT in non-hepatitis C virus/hepatitis B virus-related liver cirrhosis.World J Hepatol. 2015; 7: 2920-2926
- Portal vein thrombosis in liver cirrhosis: the role of ADAMTS13.J Thromb Haemost. 2015; 13: 268
- Frequency of portal vein thrombosis in cirrhosis on ultrasound.J Med Sci (Peshawar). 2015; 23: 11-13
- Comparison of platelets function using MultiPlate® test in cirrhotic patients with and without portal vein thrombosis.United Eur Gastroenterol J. 2014; 2: A455
- Impaired visibility of the hepatic veins on the multi-detector computed tomography in patients with cirrhosis.Eurasian J Med. 2014; 46: 198-202
- Frequency of portal vein thrombosis in patients with cirrhosis of liver transplantation candidates.Hepatol Int. 2014; 8: S323
- A single hospital study on portal vein thrombosis in cirrhotic patients - clinical characteristics & risk factors.Indian J Med Res. 2014; 139: 260-266
- Clinical outcome of gastric varices in patients with portal hypertension with or without cirrhosis without a previous history of bleeding.J Hepatol. 2014; 60: S390
- Value of D-dimer and protein S for diagnosis of portal vein thrombosis in patients with liver cirrhosis.J Int Med Res. 2013; 41: 664-672
- Anticoagulant therapy with sulodexidum for portal vein thrombosis in patients with liver cirrhosis.Hepatology. 2013; 58: 867A-868A
- Emergency anticoagulation treatment for cirrhosis patients with portal vein thrombosis and acute variceal bleeding.Scand J Gastroenterol. 2012; 47: 686-691
- The risk of thrombotic events in patients with liver cirrhosis.Rev Med Chir Soc Med Nat Iasi. 2012; 116: 991-996
- Clinical features and 1-year mortality of cirrhotic patients with and without portal vein thrombosis.Hepatol Int. 2011; 5: 357
- Protein C and D-dimer are related to portal vein thrombosis in patients with liver cirrhosis.J Gastroenterol Hepatol. 2010; 25: 116-121
- Portal vein thrombosis in Egyptian patients with liver cirrhosis: role of methylenetetrahydrofolate reductase C677T gene mutation.Hepatol Res. 2010; 40: 486-493
- Portal vein thrombosis and survival in patients with cirrhosis.Liver Transpl. 2010; 16: 83-90
- Correlation of routinely used coagulation parameters and presence of portal vein thrombosis in patients with liver cirrhosis.Hepatol Res. 2009; 39: 882-887
- The prevalence of non-tumor related portal vein thrombosis.Can J Gastroenterol. 2009; : 23
- Paraumbilical collateral veins on MRI as possible protection against portal venous thrombosis in candidates for liver transplantation.Abdom Imaging. 2008; 33: 536-541
- Soluble P selectin levels in chronic liver disease: relationship to disease severity.Hepatogastroenterology. 2007; 54: 466-469
- Evaluation of D-dimer and factor VIII in cirrhotic patients with asymptomatic portal venous thrombosis.J Lab Clin Med. 2005; 146: 238-243
- Portal vein thrombosis following endoscopic variceal sclerotherapy. Prospective controlled comparison in patients with cirrhosis.Dig Dis Sci. 1996; 41: 185-190
- Hepatic arterial resistance in cirrhosis with and without portal vein thrombosis: relationships with portal hemodynamics.Gastroenterology. 1995; 108: 1152-1158
- Comparison of splenoportography and transhepatic portography in the diagnosis of portal vein thrombosis.J Hepatol. 1986; 2: 351-357
- Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients.Gastroenterology. 1985; 89: 279-286
- No association of homocysteine, anticardiolipin antibody, and anti-β2 glycoprotein i antibody with portal venous system thrombosis in liver cirrhosis.Clin Appl Thromb Hemost. 2021; 27: 1-8
- Association of thromboelastography profile with severity of liver cirrhosis and portal venous system thrombosis.BMC Gastroenterol. 2021; 21: 253
- Frequency of portal vein thrombosis in patients with liver cirrhosis.Pak J Med Health Sci. 2021; 15: 887-888
- Risk factors of portal vein thrombosis in cirrhotic patients.United Eur Gastroenterol J. 2020; 8: 614
- Clinical characteristics of cirrhosis patients with umbilical vein recanalization: a retrospective analysis.Medicine (Baltimore). 2021; 100: e26774
- The disseminated intravascular coagulation score is a novel predictor for portal vein thrombosis in cirrhotic patients with hepatitis B.Thromb Res. 2018; 161: 7-11
- De-novo portal vein thrombosis in liver cirrhosis: risk factors and correlation with the model for end-stage liver disease scoring system.Eur J Gastroenterol Hepatol. 2015; 27: 585-592
- Incidence and outcome of newly diagnosed portal vein thrombosis in patients with cirrhosis awaiting liver transplantation.Hepatology. 2014; 60: 381A
- De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes.Am J Gastroenterol. 2013; 108: 568-574
- Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis.Gastroenterology. 2012; 143 (e4): 1253-1260
- Portal vein thrombosis (PVT) is a risk factor for death and complications in liver cirrhosis.Hepatology. 2012; 56: 935A
- Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development.J Hepatol. 2009; 51: 682-689
- Study of portal vein thrombosis in patients with idiopathic portal hypertension in Japan.Liver Int. 2005; 25: 978-983
- Natural history of compensated viral B and D cirrhosis.Rom J Gastroenterol. 2005; 14: 329-335
- Incidence and recurrence of portal vein thrombosis in cirrhotic patients.Thromb Haemost. 2019; 119: 496-499
- Natural history and predictors associated with the evolution of portal venous system thrombosis in liver cirrhosis.Eur J Gastroenterol Hepatol. 2021; 33(1S Suppl 1): e423-e430
- Risk of non-tumoral portal vein thrombosis in patients with HCV-induced cirrhosis after sustained virological response.Liver Int. 2021; 41: 2954-2964
- Non-malignant portal vein thrombosis in a cohort of cirrhotic patients: incidence and risk factors.Hepatol Res. 2021; 51: 1064-1072
- Impact of untreated portal vein thrombosis on pre and post liver transplant outcomes in cirrhosis.Ann Hepatol. 2013; 12: 952-958
- Predicting portal thrombosis in cirrhosis: a prospective study of clinical, ultrasonographic and hemostatic factors.J Hepatol. 2021; 75(6): 1367-1376
- Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors.Eur J Gastroenterol Hepatol. 2005; 17: 745-751
- Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies.World J Gastroenterol. 2006; 12: 2115-2119
- Decreased portal vein velocity is predictive of the development of portal vein thrombosis: a matched case-control study.Liver Int. 2018; 38: 94-101
- Nonselective beta-blockers and development of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis.Hepatol Int. 2019; 13: 468-481
- Association between portal vein thrombosis and survival of liver transplant recipients: a systematic review and meta-analysis of observational studies.J Gastrointest Liver Dis. 2015; 24 (4 p following 9): 51-59
- Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis.Transpl Int. 2018; 31: 1318-1329
- Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review.Transplantation. 2012; 94: 1145-1153
- Association between portal vein thrombosis and survival in non-liver-transplant patients with liver cirrhosis: a systematic review of the literature.Gastroenterol Res Pract. 2015; 2015480842
- Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: a meta-analysis.World J Hepatol. 2015; 7: 2774-2780
- Effect of portal vein thrombosis on the prognosis of patients with cirrhosis without a liver transplant: a systematic review and meta-analysis.Medicine (Baltimore). 2021; 100: e25439
- A systematic review and meta-analysis of anticoagulation therapy for portal vein thrombosis in patients with cirrhosis: to treat or not to treat?.Hepatol Int. 2021; 15: 1356-1375
- Efficacy and safety of anticoagulation in non-malignant portal vein thrombosis in patients with liver cirrhosis: a systematic review and meta-analysis.Ann Gastroenterol. 2021; 34: 104-110
- Effects of anticoagulants in patients with cirrhosis and portal vein thrombosis: a systematic review and meta-analysis.Gastroenterology. 2017; 153 (e1): 480-487
- Anticoagulation for the treatment of portal vein thrombosis in liver cirrhosis: a systematic review and meta-analysis of observational studies.Eur J Intern Med. 2015; 26: 23-29
- Anticoagulation favors thrombus recanalization and survival in patients with liver cirrhosis and portal vein thrombosis: results of a meta-analysis.Adv Ther. 2021; 38: 495-520
- Treatment response and bleeding events associated with anticoagulant therapy of portal vein thrombosis in cirrhotic patients: Systematic review and meta-analysis.Ann Gastroenterol. 2020; 33: 521-527
- Safety and efficacy of anticoagulation in patients with cirrhosis: a meta-analysis.Can J Gastroenterol Hepatol. 2021; 20218859602
- Efficacy and safety of anticoagulants in liver cirrhosis patients with portal vein thrombosis: a meta-analysis.Clin Res Hepatol Gastroenterol. 2021; 45101649
- A network meta-analysis of direct oral anticoagulants for portal vein thrombosis in cirrhosis.Hepatol Int. 2021; 15: 1196-1206
- Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist for portal vein thrombosis in cirrhosis: a systematic review and meta-analysis.Dig Liver Dis. 2022; 54: 56-62
- Consensus for management of portal vein thrombosis in liver cirrhosis (2020, Shanghai).J Dig Dis. 2021; 22: 176-186
Article info
Publication history
Published online: June 07, 2022
Accepted:
May 30,
2022
Received in revised form:
May 23,
2022
Received:
January 31,
2022
Identification
Copyright
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
