Protocolo diagnóstico y terapéutico de la trombosis portal

Abstract

Portal vein thrombosis (PVT) is occlusion of the vein by thrombotic material with or without extension to other segments of the splanchnic venous system (splenic and mesenteric vein). Portal vein occlusion due to a thrombus occurs most frequently in patients with cirrhosis. It is most often diagnosed as an incidental finding on routine imaging tests. However, non-cirrhotic DVT, despite being a rare disease with a prevalence between 0.7–3.7 per 100,000 individuals, is the second most frequent cause of portal hypertension. The clinical manifestations depend on the duration (acute or chronic) of the event. PVT is diagnosed via Doppler ultrasound and the extent and presence of associated factors is confirmed via contrast-enhanced CT/MRI. It is essential for the therapeutic approach to differentiate whether there is an underlying cirrhosis or if it has occurred in a non-cirrhotic patient. In both cases, anticoagulation is the indicated treatment. However, the duration of anticoagulation depends on other factors, including the extent, temporality, and the existence or not of associated untreatable prothrombotic disease. In addition, alternative treatments are available in the case of anticoagulation failure, including transjugular intrahepatic postosystemic shunting.