Trombosis portal en la cirrosis hepática

Abstract

Portal vein thrombosis (DVT) is defined as the partial or complete occlusion of the portal lumen or its tributaries by a thrombus. The etiology of DVT in cirrhotic patients is multifactorial, and widely recognized as the most frequent thrombotic event, presenting a variable prevalence. The pathophysiology of cirrhotic DVT is complex, and despite having traditionally been considered a prohemorrhagic condition, it is now assumed that there is an imbalance that alters the fragile hemostatic balance, resulting in decreased synthesis of both procoagulant and anticoagulant factors, which associated with local or systemic thrombophilic risk factors, tip the balance in favor of the procoagulant microenvironment. Establishing the chronology of establishment of thrombosis and the splanchnic anatomical location are fundamental aspects for decision making; face the therapeutic approach and select the type of patients who will benefit early and homogeneously. It has generated a wide debate as expressed in the recent literature, about the management and consensus on the prophylaxis or treatment of this entity, and remains controversial especially in non-tributary cirrhotics of liver transplantation. The benefit of anticoagulant therapy is objective, particularly in those with acute DVT and in the field of peritransplantation as reflected in recent clinical practice guidelines. The aim of this review is to explore the most relevant issues when approaching a patient with liver cirrhosis and DVT.