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.

Based on comments from experts, content on Wysdom, and the article cited below.

Lorenz J, Kwak DH, Martin L, et al. Endovascular Management of Noncirrhotic Acute Portomesenteric Venous Thrombosis. J Vasc Interv Radiol. 2025;36(1):17-30. doi:10.1016/j.jvir.2024.09.023