Current outcome of portal vein thrombosis in adults: Risk and benefit of anticoagulant therapy

Background & Aims: The outcome of portal vein thrombosis in relation to ass ociated prothrombotic states has not been evaluated. We assessed current ou tcome and predictors of bleeding and thrombotic events in a cohort of 136 a dults with nonmalignant, noncirrhotic portal vein thrombosis, of whom 84 re ceived anticoagulant therapy. Methods: Multivariate Cox model analysis for event-free survival and analysis taking into account multiple events were u sed. Results: Median follow-up was 46 months. The incidence rate of gastroi ntestinal bleeding was 12.5 (95% confidence interval [CI], 10-15) per 100 p atient-years. Large varices were an independent predictor for bleeding. Ant icoagulant therapy did not increase the risk or the severity of bleeding. T he incidence rate of thrombotic events was 5.5 (95% CI, 3.8-7.2) per 100 pa tient-years. Underlying prothrombotic state and absence of anticoagulant th erapy were independent predictors for thrombosis. In patients with underlyi ng prothrombotic state, the incidence rates of splanchnic venous infarction were 0.82 and 5.2 per 100 patient-years in periods with and without antico agulant therapy, respectively (P = 0.01). Two nonanticoagulated patients di ed of bleeding and thrombosis, respectively. Conclusions: In patients with portal vein thrombosis, the risk of thrombosis is currently as clinically s ignificant as the risk of bleeding. The benefit-risk ratio favors anticoagu lant therapy.