Retrospective analysis of epidemiologic, laboratory findings, clinical features and related underlying diseases in patients with portal venous thrombosis (PVT)

Objective: Portal vein thrombosis (PVT) is a disease which diagnosis and treatment can be delayed because its symptoms may be subtle, it can be confused with other diseases, and it is not one of the first diagnoses that come to mind in the etiology of abdominal pain. However, early diagnosis and initiation of treatment are important in terms of prognosis. Our study aimed to obtain real-life data for PVT, which may require urgent diagnosis and treatment, to determine its clinic in our own geography, to diagnose it quickly, to plan etiological examinations, to decide on the treatment method to be applied, and to determine the optimal follow-up strategy. Materials and Methods: The clinical features, underlying associated diseases, treatments and responses of the cases diagnosed with PVT in KTU Farabi Hospital between 2005 and 2020 were evaluated retrospectively. Results: There were a total of 410 patients included in the study, 280 (68.3%) male and 130 (31.7%) female. Patients were divided into 3 groups: 273 (66.6%) patients with malignancy (Group 1), 72 (17.6%) patients with cirrhosis without malignancy (Group 2), 65 (15.9%) patients without malignancy or cirrhosis (Group 3). The mean age at diagnosis was 60 (±13.4). 65.4% of the patients were symptomatic and 34.9% were asymptomatic. Abdominal pain was the most common complaint, seen in 47.8% of the patients. 273 patients were diagnosed with malignancy, 197 patients with cirrhosis, and 8 patients with chronic myeloproliferative disease. 85 patients had undergone intra-abdominal surgery, 20 patients had intra-abdominal inflammation, 19 patients had abdominal abscesses, and 18 patients had at least one thrombophilic factor. In total, only systemic risk factors were found in 28 patients, both systemic and local in 28 patients, only local risk factors in 341 patients, and no risk factors were detected in 13 patients. Chronic thrombosis was observed in 291 patients and acute thrombosis in 119 patients. Thrombus was limited to one of the terminal branches of the portal vein in 99 patients, it was seen in the trunk of the portal vein or in both terminal branches in 232 patients, and at least one accessory vein (splenic or superior mesenteric vein) was involved in 79 patients. Only 34.5% of the patients could be treated for PVT, and recanalization could be achieved in 35.1% of the patients with known recanalization data. Conclusions: Cirrhosis and malignancy are the most important risk factors among all causes in the development of PVT. However, it is frequently observed that thrombophilic factors are also accompanied. Since it is one of the rare causes of abdominal pain, the diagnosis of PVT may be missed and delayed. PVT should be suspected, especially if abdominal pain is accompanied by ascites and/or splenomegaly. There is a need for extensive studies on PVT in cirrhotic and non-cirrhotic patients. Keywords: Portal vein thrombosis, anticoagulation, cirrhosis, malignancy, HCC