Management of portal vein thrombosis in cirrhosis: More shadows than lights

I believe that the report on hemostatic balance in cirrhosis, recently published in Digestive and Liver Disease, adds important considerations about the topic. However, the assumption that portal vein thrombosis (PVT) in cirrhosis should be an indication to anticoagulant (AC) treatment is not obvious and should merit further debate [1]. In fact, whether PVT affects the outcome of cirrhosis still remains an open issue. In particular, although PVT in cirrhosis is associated with a bad prognosis, it is not evident whether this reflects that PVT more easily arises in the context of severe liver failure or, on the other hand, whether PVT really worsens hepatic function by reducing portal flow in a context of already reduced hepatic functional reserve, so negatively affecting survival.

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