Acute Portal Venous Thrombosis in Non-Cirrhotic Patients: When Anticoagulation Isn't Enough
This episode provides a deep dive into the management of Acute Porto-Mesenteric Venous Thrombosis (PVT) in non-cirrhotic patients, a condition with a 30-day mortality rate of up to 32% if the clot extends into the mesenteric veins.
The Limitations of Meds: We discuss why systemic anticoagulation often fails, achieving complete recanalization in only 50% of patients due to the sheer volume of clot.
The "Hidden" Drivers: Learn why an exhaustive workup is mandatory, as up to 52% of these patients have an underlying prothrombotic disorder (like JAK2 mutations) alongside local inflammation.
Interventional Strategy: The conversation highlights the shift toward Mechanical Thrombectomy (MT) combined with Catheter-Directed Thrombolysis (CDT), which data shows can reduce the duration of dangerous thrombolytic infusion from 44 hours to just 22.7 hours.
Critical Safety Caveats: We cover the specific management of VITT (Vaccine-Induced Thrombotic Thrombocytopenia), where heparin is strictly contraindicated, and the three "red flags" (Lactate >2, Marshall score >2, Bowel dilation) that signal irreversible necrosis and the need for surgery.
Tune in to master the decision matrix for saving the bowel when medical therapy fails.
