Gastrointestinal bleeding risk in cirrhotic portal vein thrombosis: focus on thrombus extension to superior mesenteric vein

Abstract Background 267 (70.3%) had non-extending PVT and 113 (29.7%) extending PVT (89 involving SMV). During follow-up, 201 (55.5%) experienced bleeding, with a 63.7% recurrence rate in the initial bleeding group. Extended PVT and SMVT-positive patients were significantly more likely to have higher baseline bleeding rates, 12-month bleeding rates, and recurrence rates compared with non-extended and SMVT-negative patients (all P < 0.05). Multivariate analysis identified SMVT extension as an independent risk factor associated with baseline (OR = 2.194; P = 0.010) and 12-month bleeding (OR = 1.962; P = 0.018). PSM confirmed significant associations between SMVT extension and gastrointestinal bleeding at baseline ( P = 0.035) and 12 months ( P = 0.033). Conclusions In patients with cirrhosis and PVT, the extension into the SMV is significantly associated with an increased risk of gastrointestinal bleeding.