Portal Vein Thrombosis in Cirrhosis: Challenges in Management and Approach, a Case Report

Portal vein thrombosis is a common complication in cirrhosis, especially in patients with decompensated disease, associated hepatocellular carcinoma, or those awaiting liver transplantation. Anticoagulation is the first-line therapy to improve transplant feasibility and outcomes in this context, although bleeding risk, particularly in the presence of portal hypertension, adds a notable challenge and complexity to its management. We report the case of a patient with cirrhosis who presented with gastrointestinal bleeding due to gastroesophageal variceal rupture and hepatic encephalopathy, complicated by porto-mesenteric thrombosis. While undergoing pre-liver transplantation workup and shortly following the beginning of anticoagulation, he developed a subdural hematoma, highlighting the complexity of risk-benefit assessment and therapeutic decision-making. Thus, this case report highlights the delicate balance between haemorrhagic risk and thrombotic benefit and supports individualized, multidisciplinary management of PVT in cirrhotic patients.