The Natural History, Treatments, and Outcomes of Portal Vein Thrombosis in Patients with Inflammatory Bowel Disease

Leonard Naymagon, Douglas Tremblay, Nicole Zubizarreta, Erin Moshier, Steven Naymagon, John Mascarenhas, Thomas Schiano

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Portal vein thrombosis (PVT) is a poorly described complication of inflammatory bowel disease (IBD). We sought to better characterize presentations, compare treatments, and assess outcomes in IBD-related PVT. Methods: We conducted a retrospective investigation of IBD-related PVT at our institution. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios across treatments. Results: Sixty-three patients with IBD-related PVT (26 with Crohn disease, 37 with ulcerative colitis) were followed for a median 21 months (interquartile ratio [IQR] = 9-52). Major risk factors included intra-abdominal surgery (60%), IBD flare (33%), and intra-abdominal infection (13%). Primary hematologic thrombophilias were rare and did not impact management. Presentations were generally nonspecific, and diagnosis was incidental. Ninety-two percent of patients (58/63) received anticoagulation (AC), including 23 who received direct oral anticoagulants (DOACs), 22 who received warfarin, and 13 who received enoxaparin. All anticoagulated patients started AC within 3 days of diagnosis. Complete radiographic resolution (CRR) of PVT occurred in 71% of patients. We found that DOACs were associated with higher CRR rates (22/23; 96%) relative to warfarin (12/22; 55%): the hazard ratio of DOACs to warfarin was 4.04 (1.83-8.93; P†=†0.0006)). Patients receiving DOACs required shorter courses of AC (median 3.9 months; IQR = 2.7-6.1) than those receiving warfarin (median 8.5 months; IQR = 3.9-NA; P†=†0.0190). Incidence of gut ischemia (n†=†3), symptomatic portal hypertension (n†=†3), major bleeding (n†=†4), and death (n†=†2) were rare, and no patients receiving DOACs experienced these adverse outcomes. Conclusions: We show that early and aggressive use of AC can lead to excellent outcomes in IBD-associated PVT and that DOACs are associated with particularly favorable outcomes in this setting.

Original languageEnglish
Pages (from-to)215-223
Number of pages9
JournalInflammatory Bowel Diseases
Issue number2
StatePublished - 1 Feb 2021


  • anticoagulation
  • direct oral anticoagulants
  • inflammatory bowel disease
  • portal vein thrombosis
  • splanchnic vein thrombosis


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