A 55-year-old man with cirrhosis due to chronic hepatitis C undergoes Doppler ultrasound, which reveals echogenic material in the main portal vein with absent flow. He has no abdominal pain, and liver enzymes are stable. Ascites is mild and controlled. Which is the most appropriate management?
- A Observation only
- B Systemic thrombolysis
- C Anticoagulation with low molecular weight heparin ✓
- D Transjugular intrahepatic portosystemic shunt (TIPS)
Correct answer: C. Anticoagulation with low molecular weight heparin
Explanation
Portal vein thrombosis (PVT) in cirrhosis is common and often asymptomatic. Anticoagulation (typically low molecular weight heparin transitioning to warfarin or DOACs) is recommended for patients with PVT, particularly if they are transplant candidates, as it can achieve partial or complete recanalization and does not increase bleeding risk significantly in compensated cirrhosis. Observation is insufficient for recent thrombosis. Thrombolysis and TIPS are reserved for acute severe cases or bowel ischemia.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.