Anticoagulation treatment of portal vein thrombosis in a patient with cirrhosis awaiting liver transplantation A case report

Rationale: Portal vein thrombosis (PVT) is relatively common in patients with liver cirrhosis waiting for liver transplantation (LT). Anticoagulation is an important non-invasive treatment strategy for patients with cirrhosis and PVT. Patient concerns: This is the case of a 51-year-old man who presented with cryptogenic liver cirrhosis associated with ascites. Computed tomography (CT) and Doppler ultrasonography (US) showed a partially obstructive thrombus of the portal vein (Yerdel Grade II). Diagnosis: Portal vein thrombosis(Yerdel Grade II); liver cirrhosis. Interventions: The PVT was completely recanalized after 4 months of treatment with the low molecular weight heparin (LMWH) medication enoxaparin but discontinuation of anticoagulants led to PVT recurrence. The patient's condition deteriorated, even though re-treating the anticoagulation with enoxaparin significantly reduced the PVT. Outcomes: The thrombus was removed by a thrombectomy and LT was performed successfully without any vascular complications. Lessons: Patients with cirrhosis and PVT who are waiting LT can be effectively treated with LMWH anticoagulants. Careful use of anticoagulation is generally safe. Early initiation of anticoagulation treatment may be associated with a high rate of portal vein recanalization.