Background and importance Portal vein thrombosis (PVT) represents a well known complication during the natural course of liver cirrhosis, ranging from asymptomatic cases to life threatening conditions related to portal hypertension and hepatic decompensation. Treatment of PVT in patients with liver cirrhosis is not well established.

Aim and objectives To assess the safety and efficacy of low molecular weight heparins (LMWH) to treat PVT in cirrhotic patients.

Material and methods Clinical charts of all patients treated with LMWH for PVT were reviewed for data on age, sex, aetiology of liver cirrhosis, presence of portal hypertension, congestive gastropathy (GC), hepatocarcinoma (HCC), treatment with LMWH, adverse events and follow-up.

Results Sixty-one patients diagnosed with PVT and cirrhosis from January 2017 to June 2019 were evaluated for anticoagulation therapy. Forty-seven patients were men, median age 61 years (range 21–84). Aetiology of cirrhosis was: alcoholic (n=10; 16%), hepatitis C–HCV (n=9; 14%), alcoholic+HCV (n=7; 11%), hepatitis B (n=3; 5%), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (n=4; 6%) and other/combined aetiology (n=28; 48%). Portal hypertension and GC were present in 57 (93%) and 52 (85%) patients, respectively. Twenty-seven patients had HCC. Fifty-five patients (90%) were diagnosed with PVT, while 1 patient had PTV and cavernoma and 3 patients had other diagnosis. Treatment was performed with nadroparin (n=24; 39%), enoxaparin (n=35; 58%) and parnaparin (n=2; 3%), according to hospital availability. At follow-up in June 2019, 42 patients had discontinued therapy. Reasons for discontinuation were: complete or partial recanalisation (n=19; 31%), orthotopic liver transplantation (n=10; 16%), death (n=2; 3%), progression of liver disease (n=3; 5%) and other (n=8; 13%). Fifty-one patients had no adverse events; the only adverse events detected were bleeding (n=6) and thrombocytopenia (n=1). Twenty-four patients had dose changes.

Conclusion and relevance LMWH were shown to be safe and well tolerated in our patients with only minor and transient side effects.

References and/or acknowledgements 1. Amitrano L, et al. Safety and efficacy of anticoagulation therapy with low molecular weight heparin for portal vein thrombosis in patients with liver cirrhosis. J Clin Gastroenterol 2010;44:448–451.

No conflict of interest.