J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 5, May 2022, pages 209-217

Risk Factors, Clinical Presentation, Diagnosis, and Treatment Outcomes of Portal Vein Thrombosis: A Five-Year Hospital-Based Study From Qatar

**Table 1.** Demographic and Clinical Characteristics of 363 Patients Involved in This Study
Variables	N (%)
Age	47.79 ± 14.48 (18 - 85 years)
Sex
Male	258 (71.1%)
Female	105 (28.9%)
Nationality
Qatari	72 (19.8%)
Non-Qatari	291 (80.2%)
Clinical presentation
Abdominal pain	160 (44.1%)
Nausea/vomiting	131 (36.1%)
Hematemesis	34 (9.4%)
Rectal bleeding	13 (3.6%)
Melena	38 (10.5%)
Fever	57 (15.7%)
Diarrhea	36 (9.9%)
Splenomegaly	158 (43.5%)
Ascites	127 (35%)
Esophageal varices	137/147
Hepatic failure	36/147
Intestinal ischemia	26 (7.2%)
Others	13 (3.6%)
Risk factors
Liver cirrhosis	147 (40.5%)
Abdominal infection	69 (19%)
Cardiovascular malformation	2 (0.5%)
Myeloproliferative disorders	17 (4.7%)
Abdominal surgery	47 (12.9%)
Oral contraceptive	5 (1.4%)
Acute pancreatitis	25 (6.9%)
Coagulation disorders	48 (12.1%)
Malignancies	108 (29.7%)
Others	13 (3.6%)
Onset
Acute	207 (57%)
Chronic	156 (43%)
Group
Non-malignant-non-cirrhotic	184 (50.7%)
Acute/chronic	136/48
Non-malignant-cirrhotic	72 (19.8%)
Acute/chronic	20/52
Malignant-cirrhotic	75 (20.7%)
Acute/chronic	47/28
Malignant-non-cirrhotic	32 (8.8%)
Acute/chronic	23/9

Table 1. Demographic and Clinical Characteristics of 363 Patients Involved in This Study

Variables

N (%)

Age

47.79 ± 14.48 (18 - 85 years)

Sex

Male

258 (71.1%)

Female

105 (28.9%)

Nationality

Qatari

72 (19.8%)

Non-Qatari

291 (80.2%)

Clinical presentation

Abdominal pain

160 (44.1%)

Nausea/vomiting

131 (36.1%)

Hematemesis

34 (9.4%)

Rectal bleeding

13 (3.6%)

Melena

38 (10.5%)

Fever

57 (15.7%)

Diarrhea

36 (9.9%)

Splenomegaly

158 (43.5%)

Ascites

127 (35%)

Esophageal varices

137/147

Hepatic failure

36/147

Intestinal ischemia

26 (7.2%)

Others

13 (3.6%)

Risk factors

Liver cirrhosis

147 (40.5%)

Abdominal infection

69 (19%)

Cardiovascular malformation

2 (0.5%)

Myeloproliferative disorders

17 (4.7%)

Abdominal surgery

47 (12.9%)

Oral contraceptive

5 (1.4%)

Acute pancreatitis

25 (6.9%)

Coagulation disorders

48 (12.1%)

Malignancies

108 (29.7%)

Others

13 (3.6%)

Onset

Acute

207 (57%)

Chronic

156 (43%)

Group

Non-malignant-non-cirrhotic

184 (50.7%)

Acute/chronic

136/48

Non-malignant-cirrhotic

72 (19.8%)

Acute/chronic

20/52

Malignant-cirrhotic

75 (20.7%)

Acute/chronic

47/28

Malignant-non-cirrhotic

32 (8.8%)

Acute/chronic

23/9

**Table 2.** Types of Malignancies as Risk Factors for Portal Vein Thrombosis in Our Study
Tumors	N (%)
Hepatocellular carcinoma	60 (16.5)
Cholangiocarcinoma	7 (1.9)
Pancreatic carcinoma	11 (3.0)
Colon carcinoma	10 (2.8)
Gastric cancer	2 (0.5)
Appendix carcinoma	2 (0.5)
Gastrointestinal stromal tumor	1 (0.25)
Breast cancer	5 (1.4)
Carcinoma of unknown primary	10 (2.8)

Table 2. Types of Malignancies as Risk Factors for Portal Vein Thrombosis in Our Study

Tumors

N (%)

Hepatocellular carcinoma

60 (16.5)

Cholangiocarcinoma

7 (1.9)

Pancreatic carcinoma

11 (3.0)

Colon carcinoma

10 (2.8)

Gastric cancer

2 (0.5)

Appendix carcinoma

2 (0.5)

Gastrointestinal stromal tumor

1 (0.25)

Breast cancer

5 (1.4)

Carcinoma of unknown primary

10 (2.8)

**Table 3.** Coagulation Disorders as Risk Factors for Portal Vein Thrombosis in Our Study
Coagulation disorders	N (%)
Factor V Leiden thrombophilia	7 (1.9)
Protein C deficiency	10 (2.6)
Protein S deficiency	12 (3.3)
Antiphospholipid syndrome	5 (1.4)
MUTHFR mutation	2 (0.5)
Prothrombin mutation	2 (0.5)
Jak2 mutation	2 (0.5)
Antithrombin III deficiency	2 (0.5)
Homocysteinemia/B12 deficiency	1 (0.25)
Paroxysmal nocturnal hemoglobinuria	1 (0.25)

Table 3. Coagulation Disorders as Risk Factors for Portal Vein Thrombosis in Our Study

Coagulation disorders

N (%)

Factor V Leiden thrombophilia

7 (1.9)

Protein C deficiency

10 (2.6)

Protein S deficiency

12 (3.3)

Antiphospholipid syndrome

5 (1.4)

MUTHFR mutation

2 (0.5)

Prothrombin mutation

2 (0.5)

Jak2 mutation

2 (0.5)

Antithrombin III deficiency

2 (0.5)

Homocysteinemia/B12 deficiency

1 (0.25)

Paroxysmal nocturnal hemoglobinuria

1 (0.25)

**Table 4.** A Comparison Between Cirrhotic and Non-Cirrhotic Patients With PVT in Relation to Clinical Presentation Laboratory Findings and Outcomes
Variables	Cirrhotic (N = 147)	Non-cirrhotic (N = 216)	P value
ALT: alanine transaminase; AST: aspartate aminotransferase; PVT: portal vein thrombosis; INR: international normalized ratio.
Age, years	54.36 ± 12.99	43.62 ± 13.85	< 0.001
Abdominal pain	102 (69.4)	185 (85.6)	< 0.001
Nausea/vomiting	60 (40.8)	100 (46.3)	0.178
Hematemesis	22 (14.9)	12 (5.6)	0.002
Rectal bleeding	5 (3.4)	8 (3.7)	0.561
Fever	15 (10.2)	42 (19.4)	0.012
Diarrhea	7 (4.8)	29 (13.4)	0.004
Splenomegaly	108 (73.5)	50 (23.1)	< 0.001
Ascites	97 (65.9)	30 (13.9)	< 0.001
Intestinal ischemia	5 (3.4)	21 (9.7)	0.016
Splenic vein involvement	25 (17.0)	76 (35.2)	< 0.001
Superior mesenteric vein involvement	27 (18.4)	103 (47.7)	< 0.001
Acute PVT	48 (32.7)	159 (73.6)	<0.001
Abdomen infection	14 (9.5)	55 (25.5)	< 0.001
Myeloproliferative disorder	2 (1.4)	15 (6.9)	0.02
Malignancy	73 (49.7)	36 (16.7)	< 0.001
Coagulation disorder	8 (5.5)	36 (16.5)	0.001
Abdominal surgery	8 (5.5)	39 (18.1)	< 0.001
Acute pancreatitis	2 (1.4)	23(10.6)	< 0.001
Albumen (g/L)	28.18 ± 8.88	33.93 ± 7.45	< 0.001
ALT (U/L)	83.89 ± 213.76	93.30 ± 346.75	0.762
AST (U/L)	159.51 ± 379.08	104.18 ± 497.04	0.253
INR	1.42 ± 0.34	1.23 ± 0.33	< 0.001
Platelets (/µL)	153.44 ± 187.91	264.64 ± 146.83	< 0.001
Hemoglobin (g/dL)	11.18 ± 2.35	12.80 ± 2.50	< 0.001
Bilirubin (µmol/L)	69.83 ± 92.01	32.44 ± 66.13	< 0.001
Mortality	45 (30.6)	26 (12.0)	< 0.001

Table 4. A Comparison Between Cirrhotic and Non-Cirrhotic Patients With PVT in Relation to Clinical Presentation Laboratory Findings and Outcomes

Variables

Cirrhotic (N = 147)

Non-cirrhotic (N = 216)

P value

ALT: alanine transaminase; AST: aspartate aminotransferase; PVT: portal vein thrombosis; INR: international normalized ratio.

Age, years

54.36 ± 12.99

43.62 ± 13.85

< 0.001

Abdominal pain

102 (69.4)

185 (85.6)

< 0.001

Nausea/vomiting

60 (40.8)

100 (46.3)

0.178

Hematemesis

22 (14.9)

12 (5.6)

0.002

Rectal bleeding

5 (3.4)

8 (3.7)

0.561

Fever

15 (10.2)

42 (19.4)

0.012

Diarrhea

7 (4.8)

29 (13.4)

0.004

Splenomegaly

108 (73.5)

50 (23.1)

< 0.001

Ascites

97 (65.9)

30 (13.9)

< 0.001

Intestinal ischemia

5 (3.4)

21 (9.7)

0.016

Splenic vein involvement

25 (17.0)

76 (35.2)

< 0.001

Superior mesenteric vein involvement

27 (18.4)

103 (47.7)

< 0.001

Acute PVT

48 (32.7)

159 (73.6)

<0.001

Abdomen infection

14 (9.5)

55 (25.5)

< 0.001

Myeloproliferative disorder

2 (1.4)

15 (6.9)

0.02

Malignancy

73 (49.7)

36 (16.7)

< 0.001

Coagulation disorder

8 (5.5)

36 (16.5)

0.001

Abdominal surgery

8 (5.5)

39 (18.1)

< 0.001

Acute pancreatitis

2 (1.4)

23(10.6)

< 0.001

Albumen (g/L)

28.18 ± 8.88

33.93 ± 7.45

< 0.001

ALT (U/L)

83.89 ± 213.76

93.30 ± 346.75

0.762

AST (U/L)

159.51 ± 379.08

104.18 ± 497.04

0.253

INR

1.42 ± 0.34

1.23 ± 0.33

< 0.001

Platelets (/µL)

153.44 ± 187.91

264.64 ± 146.83

< 0.001

Hemoglobin (g/dL)

11.18 ± 2.35

12.80 ± 2.50

< 0.001

Bilirubin (µmol/L)

69.83 ± 92.01

32.44 ± 66.13

< 0.001

Mortality

45 (30.6)

26 (12.0)

< 0.001

**Table 5.** Treatment and Treatment Outcomes in Patients With Acute and Chronic Portal Vein Thrombosis
Onset of PVT	Treatment received	Recanalization	No recanalization	No follow-up	Death
PVT: portal vein thrombosis.
Acute (N = 207)	Yes	171/207 (82.6%)	106 (61.9%)	Complete	85 (80.2%)	21 (12.2%)	44 (25.9%)	24 (14%)
				Partial	21 (19.8%)
	No	36/207 (17.4%)	5 (13.9%)	Complete	2 (40%)	21 (58.3%)	10 (27.8%)	10 (27.8%)
				Partial	3 (60%)
Chronic (N = 156)	Yes	19/156 (12.2%)	9 (47.4%)	Complete	5 (55.6%)	6 (31.6%)	4 (21%)	4 (21%)
				Partial	4 (44.4%)
	No	137/156 (87.8%)	28 (20.4%)	Complete	19 (67.9%)	66 (48.2%)	43 (31.4%)	33 (24.1%)
				Partial	9 (32.1%)

Table 5. Treatment and Treatment Outcomes in Patients With Acute and Chronic Portal Vein Thrombosis

Onset of PVT

Treatment received

Recanalization

No recanalization

No follow-up

Death

PVT: portal vein thrombosis.

Acute (N = 207)

Yes

171/207 (82.6%)

106 (61.9%)

Complete

85 (80.2%)

21 (12.2%)

44 (25.9%)

24 (14%)

Partial

21 (19.8%)

36/207 (17.4%)

5 (13.9%)

Complete

2 (40%)

21 (58.3%)

10 (27.8%)

Partial

3 (60%)

Chronic (N = 156)

Yes

19/156 (12.2%)

9 (47.4%)

Complete

5 (55.6%)

6 (31.6%)

4 (21%)

Partial

4 (44.4%)

137/156 (87.8%)

28 (20.4%)

Complete

19 (67.9%)

66 (48.2%)

43 (31.4%)

33 (24.1%)

Partial

9 (32.1%)

**Table 6.** Distribution of Patients With Respect to the Treatment Received and Comparison Between the Outcomes of the Different Treatment Modalities for PVT Used in This Study
	Heparin alone (N = 51)	Heparin/warfarin (N = 99)	Rivaroxaban (N = 40)	P value
PVT: portal vein thrombosis.
Distributions
Non-malignant-non-cirrhotic (N = 128)	15 (11.7%)	84 (65.6%)	29 (22.7%)
Non-malignant-cirrhotic (N = 28)	2 (7.1%)	15 (53.6%)	11 (39.3%)
Malignant-cirrhotic (N = 10)	10 (100%)	0	0
Malignant-non-cirrhotic (N = 24)	24 (100%)	0	0
Outcomes
Complete recanalization	22 (43.2%)	49 (49.5%)	19 (47.5%)	0.469
Partial recanalization	8 (15.7%)	12 (12.1%)	5 (12.5%)	0.821
No recanalization	14 (27.5%)	10 (10.1%)	3 (7.5%)
No follow-up	7 (13.7%)	28 (28.2%)	13 (32.5%)
Mortality	7 (13.7%)	20 (20.2%)	1 (2.5%)	0.027

Table 6. Distribution of Patients With Respect to the Treatment Received and Comparison Between the Outcomes of the Different Treatment Modalities for PVT Used in This Study

Heparin alone (N = 51)

Heparin/warfarin (N = 99)

Rivaroxaban (N = 40)

P value

PVT: portal vein thrombosis.

Distributions

Non-malignant-non-cirrhotic (N = 128)

15 (11.7%)

84 (65.6%)

29 (22.7%)

Non-malignant-cirrhotic (N = 28)

2 (7.1%)

15 (53.6%)

11 (39.3%)

Malignant-cirrhotic (N = 10)

10 (100%)

Malignant-non-cirrhotic (N = 24)

24 (100%)

Outcomes

Complete recanalization

22 (43.2%)

49 (49.5%)

19 (47.5%)

0.469

Partial recanalization

8 (15.7%)

12 (12.1%)

5 (12.5%)

0.821

No recanalization

14 (27.5%)

10 (10.1%)

3 (7.5%)

No follow-up

7 (13.7%)

28 (28.2%)

13 (32.5%)

Mortality

7 (13.7%)

20 (20.2%)

1 (2.5%)

0.027

**Table 7.** Results of Univariate Analysis of Predictors of 30-Day Mortality
Variables	Unadjusted odds ratio (95% CI)	P value
CI: confidence interval.
Age > 45 years	4.28 (2.25 - 8.15)	< 0.001
Male sex	1.82 (1.06 - 3.13)	0.03
Presence of ascites	3.27 (1.92 - 5.58)	< 0.001
Hepatic failure	5.15 (2.52 - 10.55)	< 0.001
Liver cirrhosis	3.02 (1.77 - 5.14)	< 0.001
Malignancies	5.07 (2.93 - 8.77)	< 0.001
Low albumen (< 3.5 g/dL)	3.27 (1.74 - 6.13)	< 0.001
Anemia	3.19 (1.83 - 5.56)	< 0.001
Bilirubin > 34 µmol/L)	3.67 (2.14 - 6.27)	< 0.001

Table 7. Results of Univariate Analysis of Predictors of 30-Day Mortality

Variables

Unadjusted odds ratio (95% CI)

P value

CI: confidence interval.

Age > 45 years

4.28 (2.25 - 8.15)

< 0.001

Male sex

1.82 (1.06 - 3.13)

0.03

Presence of ascites

3.27 (1.92 - 5.58)

< 0.001

Hepatic failure

5.15 (2.52 - 10.55)

< 0.001

Liver cirrhosis

3.02 (1.77 - 5.14)

< 0.001

Malignancies

5.07 (2.93 - 8.77)

< 0.001

Low albumen (< 3.5 g/dL)

3.27 (1.74 - 6.13)

< 0.001

Anemia

3.19 (1.83 - 5.56)

< 0.001

Bilirubin > 34 µmol/L)

3.67 (2.14 - 6.27)

< 0.001

**Table 8.** Results of Multivariate Analysis of Predictors of 30-Day Mortality
Variables	Adjusted odds ratio (95% CI)	P value
CI: confidence interval.
Age > 45 years	2.79 (1.39 - 5.59)	0.004
Male sex	2.31 (1.24 - 4.31)	0.008
Malignancies	3.26 (1.78 - 5.98)	< 0.001
Hepatic failure	2.94 (1.31 - 6.60)	0.009
Bilirubin > 34 µmol/L	2.21 (1.19 - 4.08)	0.01

Table 8. Results of Multivariate Analysis of Predictors of 30-Day Mortality

Variables

Adjusted odds ratio (95% CI)

P value

CI: confidence interval.

Age > 45 years

2.79 (1.39 - 5.59)

0.004

Male sex

2.31 (1.24 - 4.31)

0.008

Malignancies

3.26 (1.78 - 5.98)

< 0.001

Hepatic failure

2.94 (1.31 - 6.60)

0.009

Bilirubin > 34 µmol/L

2.21 (1.19 - 4.08)

0.01