What are the causes of portal vein thrombosis (PVT)?

From the Guidelines

Portal vein thrombosis is primarily caused by a combination of local and systemic factors, including liver cirrhosis, myeloproliferative neoplasms, and thrombophilic conditions, which disrupt normal blood flow, damage the vessel wall, or create a hypercoagulable environment. The most common causes of portal vein thrombosis (PVT) can be categorized into several key areas, including:

• Local factors, such as liver cirrhosis, which accounts for a significant proportion of cases due to altered blood flow and coagulation abnormalities 1
• Systemic factors, including myeloproliferative neoplasms, which are a common underlying cause of abdominal vein thrombosis, and thrombophilic conditions, such as Factor V Leiden mutation and antiphospholipid syndrome 1
• Other factors, such as abdominal trauma or surgery, especially splenectomy, which can damage the portal vein and initiate clot formation, and inflammatory bowel disease, which is also a significant risk factor 1 The development of PVT is often the result of a complex interplay between these factors, which can disrupt normal blood flow, damage the vessel wall, or create a hypercoagulable environment, ultimately leading to thrombosis. According to the most recent and highest quality study, the strongest factor for nontumoral PVT in patients with cirrhosis is likely advanced portal hypertension and reduced portal blood flow 1.

From the Research

Portal Vein Thrombosis Causes

The causes of portal vein thrombosis (PVT) can be attributed to a combination of local and systemic prothrombotic risk factors 2, 3, 4, 5, 6. Some of the key factors that contribute to the development of PVT include:

• Liver cirrhosis: A common underlying condition that increases the risk of PVT 3, 4, 6
• Malignancy: Certain types of cancer can increase the risk of PVT 4
• Myeloproliferative disorders: Conditions such as polycythemia vera and essential thrombocythemia can increase the risk of PVT 4
• Prothrombotic disorders: Conditions such as factor V Leiden and antithrombin deficiency can increase the risk of PVT 5
• Abdominal inflammation: Conditions such as pancreatitis and cholecystitis can increase the risk of PVT 5
• JAK2 mutation: A genetic mutation that can increase the risk of PVT 3

Local and Systemic Factors

Both local and systemic factors play a significant role in the pathogenesis of PVT 3, 4, 5. Local factors include:

• Liver fibrosis and hepatic insufficiency 3
• Portal vein obstruction or stenosis 5 Systemic factors include:
• Coagulopathy or thrombocytopenia 3
• Infections or sepsis 5
• Malignancies or myeloproliferative disorders 4