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Q J Med 2000; 93: 531-534
© 2000 Association of Physicians

Clinical features, diagnosis and outcome of acute portal vein thrombosis

C.L. Sheen, H. Lamparelli, A. Milne, I. Green and J.K. Ramage

From the North Hampshire Hospital, Basingstoke, UK

Received 9 March 2000 and in revised form 1 June 2000

The clinical features of acute portal vein thrombosis (APVT) are poorly defined in the literature. The proportion that progress to chronic PVT and the influences of various treatments are unknown. Between 1996 and 1998, nine patients presented to our hospital with varying upper gastrointestinal symptoms. They were found to have APVT by colour flow Doppler ultrasound, which was confirmed by CT scanning. All were tested for procoagulant tendencies and then treated with intravenous heparin for 7 days and warfarin for 3 months. Colour flow Doppler ultrasound or CT was done regularly to assess response to treatment. There was complete resolution of thrombus in five patients. Four patients had procoagulant tendencies identified; of these the thrombus resolved in two cases and in two cavernous transformation occurred. In most cases, the thrombus disperses on heparin and warfarin, although the effect of this therapy is unknown. A randomized trial of thrombolytic therapy may be appropriate, in an attempt to reduce the rate of progression to chronic PVT.

Dr J.K. Ramage, North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA


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