SHM Converge Scientific Abstract ePoster Gallery-Caught Between Clot and Bleed: Navigating Non-Cirrhotic Portal Vein Thrombosis

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This case report describes non-cirrhotic portal vein thrombosis (PVT), a rare condition in patients without liver cirrhosis that can range from incidental discovery to serious complications such as mesenteric ischemia or portal hypertension. The patient was a 71-year-old man with recent gallstone pancreatitis who presented with abdominal symptoms. Imaging revealed a new occlusive thrombus in the right portal venous system, confirming PVT. Because the thrombosis was likely provoked by acute pancreatitis and no alternative causes were found on initial workup, anticoagulation was started with heparin and then transitioned to rivaroxaban.<br /><br />Ten days later, the patient was readmitted with acute lower gastrointestinal bleeding and blood loss anemia while taking rivaroxaban. Colonoscopy showed diverticulosis and internal hemorrhoids but no active bleeding source. Repeat vascular imaging showed persistent PVT. Since thrombectomy was not an option, clinicians balanced the risks of ongoing thrombosis versus recurrent bleeding by switching him from rivaroxaban to a titratable heparin infusion, then discharging him on reduced-dose apixaban with plans to increase the dose later if stable.<br /><br />The discussion highlights that PVT may be recent or chronic, and management depends on timing, extent, and underlying risk factors. Recommended evaluation includes thrombophilia testing even when a provoking factor is identified. Anticoagulation is generally recommended for at least six months, and direct oral anticoagulants may be effective and potentially safer than warfarin, though evidence remains limited. This case illustrates the challenge of treating unusual-site thrombosis when bleeding complicates anticoagulation, and it supports careful individualized management.

Asset Subtitle

Mikaela Kcomt

Meta Tag

Author List Abigail Winz, Jeevitha Prativadi, Kelly Thomson, Mikaela Kcomt

Category Clinical Vignettes

Concept Non-Cirrhotic Portal Vein Thrombosis

Concept Anticoagulation

Concept Mesenteric Ischemia

Concept Portal Hypertension

Concept Thrombophilia

Distinguished Non-Finalist

Presenter Organization Department of Medicine, EVMS at ODU

Presenting Author Mikaela Kcomt

Track Adult

Keywords

non-cirrhotic portal vein thrombosis

portal vein thrombosis

gallstone pancreatitis

anticoagulation

rivaroxaban

apixaban

heparin infusion

lower gastrointestinal bleeding

thrombophilia testing

diverticulosis

Non-Cirrhotic Portal Vein Thrombosis

Anticoagulation

Mesenteric Ischemia

Portal Hypertension

Thrombophilia