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Background: The pathogenesis of portal vein thrombosis (PVT) in cirrhosis is multifactorial, with altered hemodynamics being proposed as a possible contributor. The present systematic review was conducted to study the role of assessment of portal hemodynamics for the prediction of PVT in patients with cirrhosis. Methods: Three databases (Medline, Embase, and Scopus) were searched from inception to February 2023 for studies comparing portal venous system parameters in patients with cirrhosis developing PVT with those not. Results were presented as mean difference (MD) or odds ratio (OR) with their 95% confidence intervals (CI). Results: A total of 31 studies (patients with cirrhosis: 19 studies, patients with cirrhosis undergoing splenectomy: 12 studies) were included. In patients with cirrhosis, portal vein diameter (PVD), splenic length, and splenic thickness were significantly shorter in those without PVT than those developing PVT with a MD of -1.62 (-2.51 to -0.73) cm, -1.17 (-1.59 to -0.75) cm, and -0.97 (-1.19 to -0.74) cm, respectively. On pooling the data from multivariable analyses of the included studies, a larger portal vein diameter was a significant predictor of PVT in patients with cirrhosis without or with splenectomy with OR 1.74 (1.12 – 2.69) and OR 1.55 (1.26 – 1.92), respectively (Figure 1). With each 1 cm increase in the PVD, there was 1.7 times higher odds of developing PVT in cirrhotics. On the other hand, portal vein velocity (PVV) was significantly higher in those not developing PVT than those developing PVT, with an MD of 5.23 (4.86 to 5.60) cm/s. A lower PVV was a significant predictor of PVT in cirrhotics without or with splenectomy with OR 0.93 (0.91 – 0.96) and OR 0.71 (0.61 – 0.83), respectively. With each 1 cm/s reduction in PVV, there was 1.1 times higher odds of developing PVT in cirrhotics. A PVV of < 15 cm/s was the most commonly used cut-off for the prediction of PVT. Patients developing PVT also had a significantly higher splenic length, thickness, and splenic vein velocity. Conclusion: The assessment of portal hemodynamic parameters at baseline evaluation in patients with cirrhosis may predict the development of PVT. Further studies are required to determine the optimal cut-offs for various parameters.





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American Association for the Study of Liver Diseases AASLD, The Liver Meeting, November 10-14, 2023, Boston, MA