Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study

<!DOCTYPE html> <html lang="en" > <head > <meta charset="UTF-8" /> <meta http-equiv="X-UA-Compatible" content="IE=edge" /> <meta name="HandheldFriendly" content="True" /> <meta name="MobileOptimized" content="320" /> <meta name="viewport" content="width=device-width, initial-scale=1.0" /> <link rel="stylesheet" href="/static/assets/style-70b9163a.css" /> <script type="module" crossorigin="" src="/static/assets/base_style-ec2bc71e.js"></script> <link rel="stylesheet" href="/static/assets/style-ef962842.css" /> <link rel="stylesheet" href="/static/assets/style-3ade8b5c.css" /> <script type="module" crossorigin="" src="/static/assets/article_style-d757a0dd.js"></script> <style> @media screen and (min-width: 64em) { div.pmc-wm { background: repeat-y; background-image: url("data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' width='20' height='350' xmlns:xlink='http://www.w3.org/1999/xlink'%3E%3Cdefs%3E%3Cfilter x='-.02' y='0' width='1.05' height='1' id='c'%3E%3CfeFlood flood-color='%23FFF'/%3E%3CfeComposite in='SourceGraphic'/%3E%3C/filter%3E%3Ctext id='b' font-family='Helvetica' font-size='11pt' style='opacity:1;fill:%23005ea2;stroke:none;text-anchor:middle' x='175' y='14'%3EAuthor Manuscript%3C/text%3E%3Cpath id='a' style='fill:%23005ea2' d='M0 8h350v3H0z'/%3E%3C/defs%3E%3Cuse xlink:href='%23a' transform='rotate(90 10 10)'/%3E%3Cuse xlink:href='%23b' transform='rotate(90 10 10)' filter='url(%23c)'/%3E%3C/svg%3E"); padding-left: 3rem; } } </style> <link rel="apple-touch-icon" sizes="180x180" href="/static/img/favicons/apple-touch-icon.png" /> <link rel="icon" type="image/png" sizes="48x48" href="/static/img/favicons/favicon-48x48.png" /> <link rel="icon" type="image/png" sizes="32x32" href="/static/img/favicons/favicon-32x32.png" /> <link rel="icon" type="image/png" sizes="16x16" href="/static/img/favicons/favicon-16x16.png" /> <link rel="manifest" href="/static/img/favicons/site.webmanifest" /> <link rel="mask-icon" href="/static/img/favicons/safari-pinned-tab.svg" color="#0071bc" /> <meta name="msapplication-config" content="/static/img/favicons/browserconfig.xml" /> <meta name="theme-color" content="#ffffff" /> <title> Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study - PMC </title>  <meta name="ncbi_app" content="cloudpmc-viewer" /> <meta name="ncbi_db" content="pmc" /> <meta name="ncbi_phid" content="E5FDAB80742599F303AB8000535BB89A.m_1" />  <meta name="ncbi_pdid" content="article" /> <link rel="preconnect" href="https://www.google-analytics.com" /> <link rel="dns-prefetch" href="https://cdn.ncbi.nlm.nih.gov" /> <link rel="preconnect" href="https://code.jquery.com" /> <meta name="ncbi_domain" content="nihpa"> <meta name="ncbi_type" content="fulltext"> <meta name="ncbi_pcid" content="manuscript"> <link rel="canonical" href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/"> <meta name="robots" content="INDEX,NOFOLLOW,NOARCHIVE"> <meta name="citation_journal_title" content="Liver international : official journal of the International Association for the Study of the Liver"> <meta name="citation_title" content="Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study"> <meta name="citation_author" content="Jonathan G Stine"> <meta name="citation_author_institution" content="Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Jennifer Wang"> <meta name="citation_author_institution" content="Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Puja M Shah"> <meta name="citation_author_institution" content="Department of Surgery, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Curtis K Argo"> <meta name="citation_author_institution" content="Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Nicolas Intagliata"> <meta name="citation_author_institution" content="Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Andre Uflacker"> <meta name="citation_author_institution" content="Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Stephen H Caldwell"> <meta name="citation_author_institution" content="Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_author" content="Patrick G Northup"> <meta name="citation_author_institution" content="Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA"> <meta name="citation_publication_date" content="2017 Sep 9"> <meta name="citation_volume" content="38"> <meta name="citation_issue" content="1"> <meta name="citation_firstpage" content="94"> <meta name="citation_doi" content="10.1111/liv.13500"> <meta name="citation_pmid" content="28632958"> <meta name="citation_abstract_html_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/"> <meta name="citation_fulltext_html_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/"> <meta name="citation_pdf_url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/pdf/nihms886108.pdf"> <meta name="description" content="Portal vein thrombosis (PVT) in cirrhosis may lead to hepatic decompensation and increased mortality. We aimed to investigate if decreased portal vein (PV) velocity is associated with future PVT. Data on adult patients with cirrhosis and PVT between ..."> <meta name="og:title" content="Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study"> <meta name="og:type" content="article"> <meta name="og:site_name" content="PubMed Central (PMC)"> <meta name="og:description" content="Portal vein thrombosis (PVT) in cirrhosis may lead to hepatic decompensation and increased mortality. We aimed to investigate if decreased portal vein (PV) velocity is associated with future PVT. Data on adult patients with cirrhosis and PVT between ..."> <meta name="og:url" content="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/"> <meta name="og:image" content="https://cdn.ncbi.nlm.nih.gov/pmc/cms/images/pmc-card-share.jpg?_=0"> <meta name="twitter:card" content="summary_large_image"> <meta name="twitter:site" content="@ncbi"> </head> <body > <a class="usa-skipnav " href="#main-content"> Skip to main content </a> <section class="usa-banner " aria-label="Official website of the United States government" > <div class="usa-accordion"> <header class="usa-banner__header"> <div class="usa-banner__inner"> <div class="grid-col-auto"> <img aria-hidden="true" class="usa-banner__header-flag" src="/static/img/us_flag.svg" alt="" /> </div> <div class="grid-col-fill tablet:grid-col-auto" aria-hidden="true"> <p class="usa-banner__header-text"> An official website of the United States government </p> <span class="usa-banner__header-action">Here's how you know</span> </div> <button type="button" class="usa-accordion__button usa-banner__button " aria-expanded="false" aria-controls="gov-banner-default" data-testid="storybook-django-banner" > <span class="usa-banner__button-text">Here's how you know</span> </button> </div> </header> <div class="usa-banner__content usa-accordion__content" id="gov-banner-default" hidden> <div class="grid-row grid-gap-lg"> <div class="usa-banner__guidance tablet:grid-col-6"> <img class="usa-banner__icon usa-media-block__img" src="/static/img/icon-dot-gov.svg" alt="" aria-hidden="true" /> <div class="usa-media-block__body"> <p> <strong>Official websites use .gov</strong> <br /> A <strong>.gov</strong> website belongs to an official government organization in the United States. </p> </div> </div> <div class="usa-banner__guidance tablet:grid-col-6"> <img class="usa-banner__icon usa-media-block__img" src="/static/img/icon-https.svg" alt="" aria-hidden="true" /> <div class="usa-media-block__body"> <p> <strong>Secure .gov websites use HTTPS</strong> <br /> A <strong>lock</strong> ( <span class="icon-lock"> <svg xmlns="http://www.w3.org/2000/svg" width="52" height="64" viewBox="0 0 52 64" class="usa-banner__lock-image" role="graphics-symbol" aria-labelledby="banner-lock-description" focusable="false"> <title id="banner-lock-title">Lock</title> <desc id="banner-lock-description"> Locked padlock icon </desc> <path fill="#000000" fill-rule="evenodd" d="M26 0c10.493 0 19 8.507 19 19v9h3a4 4 0 0 1 4 4v28a4 4 0 0 1-4 4H4a4 4 0 0 1-4-4V32a4 4 0 0 1 4-4h3v-9C7 8.507 15.507 0 26 0zm0 8c-5.979 0-10.843 4.77-10.996 10.712L15 19v9h22v-9c0-6.075-4.925-11-11-11z" /> </svg> </span>) or <strong>https://</strong> means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. </p> </div> </div> </div> </div> </div> </section> <div class="usa-overlay"> </div> <header class="usa-header usa-header--extended usa-header--wide" data-testid="header" data-header > <div class="ncbi-header"> <div class="ncbi-header__container"> <a class="ncbi-header__logo-container" href="/"> <img alt=" PMC home page " class="ncbi-header__logo-image" src="/static/img/ncbi-logos/nih-nlm-ncbi--white.svg" /> </a>  <button type="button" class="usa-menu-btn ncbi-header__hamburger-button " aria-label="Show menu" data-testid="navMenuButton" > <svg aria-hidden="true" class="ncbi-hamburger-icon" fill="none" focusable="false" height="21" viewBox="0 0 31 21" width="31" xmlns="http://www.w3.org/2000/svg"> <path clip-rule="evenodd" d="M0.125 20.75H30.875V17.3333H0.125V20.75ZM0.125 12.2083H30.875V8.79167H0.125V12.2083ZM0.125 0.25V3.66667H30.875V0.25H0.125Z" fill="#F1F1F1" fill-rule="evenodd" /> </svg> </button>  <div class="ncbi-header__desktop-buttons">  <button type="button" class="usa-button usa-button--unstyled ncbi-header__desktop-button " aria-expanded="false" aria-controls="search-field-desktop-navigation" aria-label="Show search overlay" data-testid="toggleSearchPanelButton" data-toggle-search-panel-button > <svg class="usa-icon " role="graphics-symbol" aria-hidden="true" > <use xlink:href="/static/img/sprite.svg#search" /> </svg> Search </button>  <div class="ncbi-header__login-dropdown"> <button type="button" class="usa-button usa-button--unstyled ncbi-header__desktop-button ncbi-header__login-dropdown-button " aria-expanded="false" aria-controls="login-dropdown-menu" aria-label="Show login menu" data-testid="toggleLoginMenuDropdown" data-desktop-login-button > <svg class="usa-icon " role="graphics-symbol" aria-hidden="true" > <use xlink:href="/static/img/sprite.svg#person" /> </svg> <span data-login-dropdown-text>Log in</span>  <svg class="usa-icon ncbi-header__login-dropdown-icon ncbi-header__login-dropdown-icon--expand-less ncbi-header__login-dropdown-icon--hidden" role="graphics-symbol" aria-hidden="true" data-login-dropdown-up-arrow> <use xlink:href="/static/img/sprite.svg#expand_less" /> </svg>  <svg class="usa-icon ncbi-header__login-dropdown-icon ncbi-header__login-dropdown-icon--expand-more ncbi-header__login-dropdown-icon--hidden" role="graphics-symbol" aria-hidden="true" data-login-dropdown-down-arrow> <use xlink:href="/static/img/sprite.svg#expand_more" /> </svg> </button>  <ul class="usa-nav__submenu ncbi-header__login-dropdown-menu" id="login-dropdown-menu" data-desktop-login-menu-dropdown hidden> <li class="usa-nav__submenu-item">  <a href="https://www.ncbi.nlm.nih.gov/myncbi/" class="usa-link " > Dashboard </a> </li> <li class="usa-nav__submenu-item">  <a href="https://www.ncbi.nlm.nih.gov/myncbi/collections/bibliography/" class="usa-link " > Publications </a> </li> <li class="usa-nav__submenu-item">  <a href="https://www.ncbi.nlm.nih.gov/account/settings/" class="usa-link " > Account settings </a> </li> <li class="usa-nav__submenu-item"> <button type="button" class="usa-button usa-button--outline ncbi-header__login-dropdown-logout-button " data-testid="desktopLogoutButton" data-desktop-logout-button > Log out </button> </li> </ul> </div> </div> </div> </div>  <div class="ncbi-search-panel ncbi--show-only-at-desktop" data-testid="searchPanel" data-header-search-panel hidden> <div class="ncbi-search-panel__container"> <form action="https://www.ncbi.nlm.nih.gov/search/all/" aria-describedby="search-field-desktop-navigation-help-text" autocomplete="off" class="usa-search usa-search--big ncbi-search-panel__form" data-testid="form" method="GET" role="search"> <label class="usa-sr-only" data-testid="label" for="search-field-desktop-navigation"> Search… </label> <input class="usa-input" data-testid="textInput" id="search-field-desktop-navigation" name="term" placeholder="Search NCBI" type="search" value="" /> <button type="submit" class="usa-button " data-testid="button" > <span class="usa-search__submit-text"> Search NCBI </span> </button> </form> </div> </div> <nav aria-label="Primary navigation" class="usa-nav"> <p class="usa-sr-only" id="primary-navigation-sr-only-title"> Primary site navigation </p>  <button type="button" class="usa-nav__close ncbi-nav__close-button " aria-label="Close navigation menu" data-testid="navCloseButton" > <img src="/static/img/usa-icons/close.svg" alt="Close" /> </button>  <form class="usa-search usa-search--small ncbi--hide-at-desktop margin-top-6" role="search"> <label class="usa-sr-only" for="search-field"> Search </label> <input class="usa-input" id="search-field-mobile-navigation" type="search" placeholder="Search NCBI" name="search" /> <button type="submit" class="usa-button " >  <img src="data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIGhlaWdodD0iMjQiIHZpZXdCb3g9IjAgMCAyNCAyNCIgd2lkdGg9IjI0Ij48cGF0aCBkPSJNMCAwaDI0djI0SDB6IiBmaWxsPSJub25lIi8+PHBhdGggZmlsbD0iI2ZmZiIgZD0iTTE1LjUgMTRoLS43OWwtLjI4LS4yN0E2LjQ3MSA2LjQ3MSAwIDAgMCAxNiA5LjUgNi41IDYuNSAwIDEgMCA5LjUgMTZjMS42MSAwIDMuMDktLjU5IDQuMjMtMS41N2wuMjcuMjh2Ljc5bDUgNC45OUwyMC40OSAxOWwtNC45OS01em0tNiAwQzcuMDEgMTQgNSAxMS45OSA1IDkuNVM3LjAxIDUgOS41IDUgMTQgNy4wMSAxNCA5LjUgMTEuOTkgMTQgOS41IDE0eiIvPjwvc3ZnPg==" class="usa-search__submit-icon" alt="Search" /> </button> </form>   <div class="ncbi-nav__mobile-login-menu ncbi--hide-at-desktop" data-mobile-login-menu hidden> <p class="ncbi-nav__mobile-login-menu-status"> Logged in as: <strong class="ncbi-nav__mobile-login-menu-email" data-mobile-login-email-text></strong> </p> <ul class="usa-nav__primary usa-accordion"> <li class="usa-nav__primary-item"> <a href="https://www.ncbi.nlm.nih.gov/myncbi/" class="usa-link " > Dashboard </a> </li> <li class="usa-nav__primary-item"> <a href="https://www.ncbi.nlm.nih.gov/myncbi/collections/bibliography/" class="usa-link " > Publications </a> </li> <li class="usa-nav__primary-item"> <a href="https://www.ncbi.nlm.nih.gov/account/settings/" class="usa-link " > Account settings </a> </li> </ul> </div> <button type="button" class="usa-button ncbi-nav__mobile-login-button ncbi--hide-at-desktop " data-testid="mobileLoginButton" data-mobile-login-button > Log in </button> </nav> </header> <section class="pmc-header pmc-header--basic" aria-label="PMC Header with search box"> <div class="pmc-nav-container"> <div class="pmc-header__bar"> <div class="pmc-header__logo"> <a href="/" title="Home" aria-label="PMC Home"></a> </div> <button type="button" class="usa-button usa-button--unstyled pmc-header__search__button" aria-label="Open search" data-ga-category="search" data-ga-action="PMC" data-ga-label="pmc_search_panel_mobile" > <svg class="usa-icon width-4 height-4 pmc-icon__open" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#search"></use> </svg> <svg class="usa-icon width-4 height-4 pmc-icon__close" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#close"></use> </svg> </button> </div> <div class="pmc-header__search"> <form class="usa-search usa-search--extra usa-search--article-right-column pmc-header__search__form" autocomplete="off" role="search"> <label class="usa-sr-only" for="pmc-search">Search PMC Full-Text Archive</label> <span class="autoComplete_wrapper flex-1"> <input class="usa-input width-full maxw-none" required="required" placeholder="Search PMC Full-Text Archive" id="pmc-search" type="search" name="term" data-autocomplete-url="/search/autocomplete/"/> </span> <button class="usa-button" type="submit" formaction="https://www.ncbi.nlm.nih.gov/pmc/" data-ga-category="search" data-ga-action="PMC" data-ga-label="PMC_search_button" > <span class="usa-search__submit-text">Search in PMC</span> <img src="/static/img/usa-icons-bg/search--white.svg" class="usa-search__submit-icon" alt="Search" /> </button> </form> <ul class="pmc-header__search__menu"> <li> <a class="usa-link" href="https://www.ncbi.nlm.nih.gov/pmc/advanced/" data-ga-action="featured_link" data-ga-label="advanced_search"> Advanced Search </a> </li> <li> <a class="usa-link" href="/journals/" data-ga-action="featured_link" data-ga-label="journal list"> Journal List </a> </li> <li> <a class="usa-link" href="/about/userguide/" data-ga-action="featured_link" data-ga-label="user guide"> User Guide </a> </li> </ul> </div> </div> </section> <div class="usa-section padding-top-0 desktop:padding-top-6 pmc-article-section" data-article-db="pmc" data-article-id="10540634"> <div class="grid-container pmc-actions-bar" aria-label="Actions bar" role="complementary"> <div class="grid-row"> <div class="grid-col-fill display-flex"> <div class="display-flex"> <ul class="usa-list usa-list--unstyled usa-list--horizontal"> <li class="margin-right-2 mobile-lg:margin-right-4 display-flex mob"> <button type="button" class="usa-button pmc-sidenav__container__open usa-button--unstyled width-auto display-flex" aria-label="Open resources" data-extra-class="is-visible-resources" data-ga-category="resources_accordion" data-ga-action="click" data-ga-label="mobile_icon" > <svg class="usa-icon width-4 height-4" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#more_vert"></use> </svg> </button> </li> <li class="margin-right-2 mobile-lg:margin-right-4 display-flex mob"> <a href="https://doi.org/10.1111/liv.13500" class="usa-link display-flex" role="button" target="_blank" rel="noreferrer noopener" aria-label="View on publisher site" data-ga-category="actions" data-ga-action="click" data-ga-label="publisher_link_mobile" > <svg class="usa-icon width-4 height-4" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#launch"></use> </svg> </a> </li> <li class="margin-right-2 mobile-lg:margin-right-4 display-flex"> <a href="pdf/nihms886108.pdf" class="usa-link display-flex" role="button" aria-label="Download PDF" data-ga-category="actions" data-ga-action="click" data-ga-label="pdf_download_mobile" > <svg class="usa-icon width-4 height-4" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#file_download"></use> </svg> </a> </li> <li class="margin-right-2 mobile-lg:margin-right-4 display-flex"> <button class="usa-button usa-button--unstyled collections-dialog-trigger collections-button display-flex collections-button-empty" aria-label="Save article in MyNCBI collections." data-ga-category="actions" data-ga-action="click" data-ga-label="collections_button_mobile" data-collections-open-dialog-enabled="false" data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpmc.ncbi.nlm.nih.gov%2Farticles%2FPMC10540634%2F%23open-collections-dialog" data-in-collections="false" > <svg class="usa-icon width-4 height-4 usa-icon--bookmark-full" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/action-bookmark-full.svg#icon"></use> </svg> <svg class="usa-icon width-4 height-4 usa-icon--bookmark-empty" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/action-bookmark-empty.svg#icon"></use> </svg> </button> </li> <li class="margin-right-2 mobile-lg:margin-right-4 display-flex"> <button role="button" class="usa-button usa-button--unstyled citation-dialog-trigger display-flex" aria-label="Open dialog with citation text in different styles" data-ga-category="actions" data-ga-action="open" data-ga-label="cite_mobile" data-all-citations-url="/resources/citations/10540634/" data-citation-style="nlm" data-download-format-link="/resources/citations/10540634/export/" > <svg class="usa-icon width-4 height-4 usa-icon--bookmark-empty" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/sprite.svg#format_quote"></use> </svg> </button> </li> <li class="pmc-permalink display-flex"> <button type="button" class="usa-button usa-button--unstyled display-flex" aria-label="Show article permalink" aria-expanded="false" aria-haspopup="true" data-ga-category="actions" data-ga-action="open" data-ga-label="permalink_mobile" > <svg class="usa-icon width-4 height-4" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#share"></use> </svg> </button> <div class="pmc-permalink__dropdown" hidden> <div class="pmc-permalink__dropdown__container"> <h2 class="usa-modal__heading margin-top-0 margin-bottom-2">PERMALINK</h2> <div class="pmc-permalink__dropdown__content"> <input type="text" class="usa-input" value="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/" aria-label="Article permalink"> <button class="usa-button display-inline-flex pmc-permalink__dropdown__copy__btn margin-right-0" title="Copy article permalink" data-ga-category="save_share" data-ga-action="link" data-ga-label="copy_link"> <svg class="usa-icon" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#content_copy"></use> </svg> <span class="margin-left-1">Copy</span> </button> </div> </div> </div> </li> </ul> </div> <button type="button" class="usa-button pmc-sidenav__container__open usa-button--unstyled width-auto display-flex" aria-label="Open article navigation" data-extra-class="is-visible-in-page" data-ga-category="actions" data-ga-action="open" data-ga-label="article_nav_mobile" > <svg class="usa-icon width-4 height-4" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#list"></use> </svg> </button> </div> </div> </div> <div class="grid-container desktop:padding-left-6"> <div id="article-container" class="grid-row grid-gap"> <div class="grid-col-12 desktop:grid-col-8 order-2 pmc-layout__content"> <div class="grid-container padding-left-0 padding-right-0"> <div class="grid-row desktop:margin-left-neg-6"> <div class="grid-col-12"> <div class="pmc-layout__disclaimer" role="complementary" aria-label="Disclaimer note"> As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health.<br/> Learn more: <a class="usa-link" data-ga-category="Link click" data-ga-action="Disclaimer" data-ga-label="New disclaimer box" href="/about/disclaimer/">PMC Disclaimer</a> | <a class="usa-link" data-ga-category="Link click" data-ga-action="PMC Copyright Notice" data-ga-label="New disclaimer box" href="/about/copyright/"> PMC Copyright Notice </a> </div> </div> </div> <div class="grid-row pmc-wm desktop:margin-left-neg-6">  <main id="main-content" class="usa-layout-docs__main usa-layout-docs grid-col-12 pmc-layout pmc-prose padding-0" > <section class="pmc-journal-banner text-center line-height-none" aria-label="Journal banner"><img src="https://cdn.ncbi.nlm.nih.gov/pmc/banners/logo-nihpa.png" alt="NIHPA Author Manuscripts logo" usemap="#pmc-banner-imagemap" width="500" height="75"><map name="pmc-banner-imagemap"><area alt="Link to NIHPA Author Manuscripts" title="Link to NIHPA Author Manuscripts" shape="default" href="https://www.hhs.gov/open/public-access-guiding-principles/index.html" target="_blank" rel="noopener noreferrer"></map></section><article lang="en"><section aria-label="Article citation and metadata"><section class="pmc-layout__citation font-secondary font-xs"><div> <div class="display-inline-block"><button type="button" class="cursor-pointer text-no-underline bg-transparent border-0 padding-0 text-left margin-0 text-normal text-primary" aria-controls="journal_context_menu">Liver Int</button></div>. Author manuscript; available in PMC: 2023 Sep 29.</div> <div> <em>Published in final edited form as: </em>Liver Int. 2017 Sep 9;38(1):94–101. doi: <a href="https://doi.org/10.1111/liv.13500" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">10.1111/liv.13500</a> </div> <nav id="journal_context_menu" hidden="hidden"><ul class="menu-list font-family-ui" role="menu"> <li role="presentation"><a href="https://www.ncbi.nlm.nih.gov/pmc/?term=%22Liver%20Int%22%5Bjour%5D" class="usa-link" role="menuitem">Search in PMC</a></li> <li role="presentation"><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Liver%20Int%22%5Bjour%5D" lang="en" class="usa-link" role="menuitem">Search in PubMed</a></li> <li role="presentation"><a href="https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Liver%20Int%22%5BTitle%20Abbreviation%5D" class="usa-link" role="menuitem">View in NLM Catalog</a></li> <li role="presentation"><a href="?term=%22Liver%20Int%22%5Bjour%5D" class="usa-link" role="menuitem" data-add-to-search="true">Add to search</a></li> </ul></nav></section><section class="front-matter"><div class="ameta p font-secondary font-xs"> <hgroup><h1>Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study</h1></hgroup><div class="cg p"> <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Stine%20JG%22%5BAuthor%5D" class="usa-link" aria-describedby="id1"><span class="name western">Jonathan G Stine</span></a><div hidden="hidden" id="id1"> <h3> <span class="name western">Jonathan G Stine</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Stine%20JG%22%5BAuthor%5D" class="usa-link"><span class="name western">Jonathan G Stine</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Wang%20J%22%5BAuthor%5D" class="usa-link" aria-describedby="id2"><span class="name western">Jennifer Wang</span></a><div hidden="hidden" id="id2"> <h3> <span class="name western">Jennifer Wang</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>2</sup>Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Wang%20J%22%5BAuthor%5D" class="usa-link"><span class="name western">Jennifer Wang</span></a> </div> </div> <sup>2</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Shah%20PM%22%5BAuthor%5D" class="usa-link" aria-describedby="id3"><span class="name western">Puja M Shah</span></a><div hidden="hidden" id="id3"> <h3> <span class="name western">Puja M Shah</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>3</sup>Department of Surgery, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Shah%20PM%22%5BAuthor%5D" class="usa-link"><span class="name western">Puja M Shah</span></a> </div> </div> <sup>3</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Argo%20CK%22%5BAuthor%5D" class="usa-link" aria-describedby="id4"><span class="name western">Curtis K Argo</span></a><div hidden="hidden" id="id4"> <h3> <span class="name western">Curtis K Argo</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Argo%20CK%22%5BAuthor%5D" class="usa-link"><span class="name western">Curtis K Argo</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Intagliata%20N%22%5BAuthor%5D" class="usa-link" aria-describedby="id5"><span class="name western">Nicolas Intagliata</span></a><div hidden="hidden" id="id5"> <h3> <span class="name western">Nicolas Intagliata</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Intagliata%20N%22%5BAuthor%5D" class="usa-link"><span class="name western">Nicolas Intagliata</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Uflacker%20A%22%5BAuthor%5D" class="usa-link" aria-describedby="id6"><span class="name western">Andre Uflacker</span></a><div hidden="hidden" id="id6"> <h3> <span class="name western">Andre Uflacker</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>4</sup>Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Uflacker%20A%22%5BAuthor%5D" class="usa-link"><span class="name western">Andre Uflacker</span></a> </div> </div> <sup>4</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Caldwell%20SH%22%5BAuthor%5D" class="usa-link" aria-describedby="id7"><span class="name western">Stephen H Caldwell</span></a><div hidden="hidden" id="id7"> <h3> <span class="name western">Stephen H Caldwell</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Caldwell%20SH%22%5BAuthor%5D" class="usa-link"><span class="name western">Stephen H Caldwell</span></a> </div> </div> <sup>1</sup>, <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Northup%20PG%22%5BAuthor%5D" class="usa-link" aria-describedby="id8"><span class="name western">Patrick G Northup</span></a><div hidden="hidden" id="id8"> <h3> <span class="name western">Patrick G Northup</span>, <span class="degrees">MD</span> </h3> <div class="p"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div class="p">Find articles by <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Northup%20PG%22%5BAuthor%5D" class="usa-link"><span class="name western">Patrick G Northup</span></a> </div> </div> <sup>1</sup> </div> <ul class="d-buttons inline-list"> <li><button class="d-button" aria-controls="aip_a" aria-expanded="false">Author information</button></li> <li><button class="d-button" aria-controls="anp_a" aria-expanded="false">Article notes</button></li> <li><button class="d-button" aria-controls="clp_a" aria-expanded="false">Copyright and License information</button></li> </ul> <div class="d-panels font-secondary-light"> <div id="aip_a" class="d-panel p" style="display: none"> <div class="p" id="A1"> <sup>1</sup>Center for the Study of Coagulation Disorders in Liver Disease, Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div id="A2"> <sup>2</sup>Department of Medicine, University of Virginia, Charlottesville, VA, USA</div> <div id="A3"> <sup>3</sup>Department of Surgery, University of Virginia, Charlottesville, VA, USA</div> <div id="A4"> <sup>4</sup>Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, USA</div> <div class="author-notes p"><div class="fn" id="FN1"> <sup>✉</sup><p class="display-inline">Correspondence: Jonathan G. Stine, MD MSc, FACP, Division of Gastroenterology and Hepatology, JPA and Lee Street, MSB 2145, PO Box 800708, University of Virginia, Charlottesville, VA 22908-0708, Office: 434.297.7509, Fax: 434.244.9454</p> </div></div> </div> <div id="anp_a" class="d-panel p" style="display: none"><div class="notes p"><section id="historyarticle-meta1" class="history"><p>Issue date 2018 Jan.</p></section></div></div> <div id="clp_a" class="d-panel p" style="display: none"><div class="p"><a href="/about/copyright/" class="usa-link">PMC Copyright notice</a></div></div> </div> <div>PMCID: PMC10540634 NIHMSID: NIHMS886108 PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/28632958/" class="usa-link">28632958</a> </div> <div class="ra xbox p" role="complementary" aria-label="Related or updated information about this article"><div>The publisher's version of this article is available at <a href="https://doi.org/10.1111/liv.13500" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Liver Int</a> </div></div> </div></section></section><section aria-label="Article content"><section class="body main-article-body"><section class="abstract" id="abstract1"><h2>Abstract</h2> <section id="S1"><h3 class="pmc_sec_title">Background & Aims</h3> <p id="P1">Portal vein thrombosis (PVT) in cirrhosis may lead to hepatic decompensation and increased mortality. We aimed to investigate if decreased portal vein (PV) velocity is associated with future PVT.</p></section><section id="S2"><h3 class="pmc_sec_title">Methods</h3> <p id="P2">Data on adult patients with cirrhosis and PVT between January 1, 2005 and July 30, 2015 were obtained. Cases with PVT were matched by age, gender and Model for End stage Liver Disease (MELD) score to corresponding controls without PVT. Cox proportional hazards models, receiver operator curves and Kaplan Meier curves were constructed.</p></section><section id="S3"><h3 class="pmc_sec_title">Results</h3> <p id="P3">One hundred subjects (50 matched pairs) with mean age 53.8 +/− 13.1 years and MELD score 14.9 +/− 5.5 were included in our analysis. 64% were male and 76% were Child-Turcotte-Pugh Class A or B. Baseline characteristics (prior to development of PVT) were similar, except for baseline PV velocity (16.9 cm/s, 95% CI 13.9–20.0 PVT vs. 25.0, 95% CI 21.8–28.8 no PVT, p<0.001). 30 PVT subjects had PV velocity <15 cm/s compared to five without PVT (p<0.001). On adjusted multivariable analysis, PV velocity was the strongest independent risk factor predicting PVT development (HR 0.86, 95% CI 0.80–0.93). The predictive value for PVT development was greatest for flow < 15 cm/s (c-statistic 0.77). PV velocity <15cm/s had a highly significant association with future PVT (HR 6.00, 95% CI 2.20–16.40, p=<0.001).</p></section><section id="S4"><h3 class="pmc_sec_title">Conclusions</h3> <p id="P4">Decreased PV velocity is associated with increased risk of future PVT. Patients with cirrhosis and decreased PV velocity are a high-risk subgroup that warrants further investigation with prospective study.</p></section><section id="kwd-group1" class="kwd-group"><p><strong>Keywords:</strong> Cirrhosis, coagulopathy, thrombosis, prohemostasis</p></section></section><section id="S5"><h2 class="pmc_sec_title">INTRODUCTION</h2> <p id="P5">Portal vein thrombosis (PVT) is classified by the timing of occurrence and extent of vascular involvement.(<a href="#R1" class="usa-link" aria-describedby="R1">1</a>) PVT commonly occurs in patients with cirrhosis with prevalence rates as high as 30% at the time of liver transplantation.(<a href="#R2" class="usa-link" aria-describedby="R2">2</a>–<a href="#R4" class="usa-link" aria-describedby="R4">4</a>) Numerous studies have found that PVT is associated with worse outcomes pre- and post- liver transplantation.(<a href="#R5" class="usa-link" aria-describedby="R5">5</a>–<a href="#R10" class="usa-link" aria-describedby="R10">10</a>) Although controversial, potential adverse outcomes include increased hepatic decompensation, pre- and post-transplantation mortality, post-transplantation complications, hepatic artery thrombosis, and decreased quality of life.(<a href="#R5" class="usa-link" aria-describedby="R5">5</a>–<a href="#R10" class="usa-link" aria-describedby="R10">10</a>) Contradictory evidence exists based on analyses of large national registries and questions remain regarding the role of PVT in cirrhosis.(<a href="#R11" class="usa-link" aria-describedby="R11">11</a>, <a href="#R12" class="usa-link" aria-describedby="R12">12</a>) Development of PVT is a multifactorial process. Cirrhosis and portal hypertension cause changes in liver architecture leading to endothelial cell activation and dysfunction in the setting of impaired portal vein (PV) flow.(<a href="#R5" class="usa-link" aria-describedby="R5">5</a>, <a href="#R13" class="usa-link" aria-describedby="R13">13</a>) PV flow is inversely related to Child-Turcotte-Pugh (CTP) score,(<a href="#R14" class="usa-link" aria-describedby="R14">14</a>) and rates <10 cm/s are associated with increased mortality.(<a href="#R15" class="usa-link" aria-describedby="R15">15</a>) The threshold of flow rate at which PVT risk significantly increases remains unknown. One published report by Zocco et al(<a href="#R13" class="usa-link" aria-describedby="R13">13</a>) found PV flow <15 cm/s to be associated with the development of PVT. This report was limited by a low event rate of PVT, no control arm, statistical imprecision reflected by exceedingly large confidence, exclusion of high-risk patients with inherited thrombophilia, an no adjustment for portosystemic shunting.(<a href="#R16" class="usa-link" aria-describedby="R16">16</a>, <a href="#R17" class="usa-link" aria-describedby="R17">17</a>) In this investigation, we performed a matched case-control study examining the primary hypothesis that PV flow is inversely associated with the development of PVT.</p></section><section id="S6"><h2 class="pmc_sec_title">MATERIALS & METHODS</h2> <section id="S7"><h3 class="pmc_sec_title">Case and Control Selection</h3> <p id="P6">Data on all adult patients with cirrhosis and PVT between January 1, 2005 and July 30, 2015 were obtained from the University of Virginia Clinical Data Repository using billing and administrative codes. Cirrhosis of the liver was confirmed by histological examination of liver biopsy or by biochemical, imaging or endoscopic findings suggesting advanced liver disease with portal hypertension. PVT was detected by imaging with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) that showed a definitive thrombus. Obtaining abdominal ultrasound with hepatic portal Doppler is standard of care at our institution for both the inpatient and outpatient setting in evaluating patients with cirrhosis. The thrombus was further classified by degree of thrombosis (partial or occlusive, the latter of which was further subdivided into those subjects with and without cavernous transformation with collateralization) and location in either the portal vein (main, right and/or left) with extension to the superior mesenteric vein or splenic vein. Cases with PVT were matched 1:1 by age (within five years), gender and Model for End stage Liver Disease (MELD) score (within 2 points) to the corresponding controls with cirrhosis but no PVT. MELD score was calculated using the standard formula: 11.2*ln(INR)+9.57*ln[creatinine(mg/dL)]+3.78*ln[bilirubin(mg/dL)]+ 6.43 with a lower limit of 1.0 for all variables.(<a href="#R18" class="usa-link" aria-describedby="R18">18</a>) Patients with PVT in the absence of cirrhosis, transjugular intrahepatic portosystemic shunts (TIPS), and tumor thrombus associated with hepatocellular carcinoma (HCC), as defined by the radiology report in the patient medical record and confirmed by expert opinion, or active non-HCC malignancy were excluded. Cases were required to have an index ultrasound with portal venous Doppler ≥30 days prior to the initial diagnosis of PVT. The time frame between the index ultrasound and the time of PVT diagnosis, death, transplantation or last known status was extracted from the medical record by trained study personnel. Controls were time matched within 30 days of initial ultrasound. Controls were assumed not to have PVT based on ICD-9 codes and direct review of the ultrasound images. The diagnosis of PVT was confirmed by review by trained study personnel of available imaging. Baseline patient characteristics were reviewed, including demographics, etiology of liver disease with portal hypertensive complications (gastroesophageal varices, ascites, and hepatic encephalopathy), medications (including pro- and anticoagulants), laboratory values, and imaging including portal Doppler measurements.</p></section><section id="S8"><h3 class="pmc_sec_title">Ultrasound with Hepatic Portal Doppler Measurements</h3> <p id="P7">Patients were examined with Color-Power Doppler Ultrasound (US) scanners, which included the Philips Epiq 7G (Philips Ultrasound, Inc., Reedsville, PA), Siemens ACUSON (Siemens Medical Solutions USA, Inc., Malvern, PA), and SuperSonic Aixplorer (SuperSonic Imagine, Bothell, WA). Most patients were examined with a 5MHz convex PureWave C 5-1 probe (Philips Ultrasound, Inc.), and some patients with thinner body habitus were examined with a 9MHz convex PureWave C 9-1 probe (Philips Ultrasound, Inc.), at the discretion of the examining sonographer.</p> <p id="P8">All studies were performed by certified sonographers. Patients were required to be fasting >6 hours per our standard institutional protocol. Examination of PV velocities was made in a supine position after approximately 10 minutes of rest. Patients were given detailed instructions on standard breathing patterns in order to minimize respiratory variation. The main PV was identified as the segment between the hepatic hilum and the junction of the splenic vein and superior mesenteric vein by positioning the probe from the epigastrium at a slightly oblique angle. The angle of insonation was kept between 0 and 60 degrees, and the Doppler velocity was obtained within the center of the main portal vein where laminar flow is greatest.</p> <p id="P9">Main PV velocity was automatically calculated by the scanner as the time averaged maximum velocity in, with at least one tracing, and each tracing lasting between 4–6 seconds. The main PV velocity was then recorded in cm/s. For the purposes of this study, portal velocities were acquired from the reported velocity in the finalized radiology report found in the medical record and confirmed by trained independent study investigators utilizing the velocity from the portal wave form tracing of the main PV. If the velocity was not documented in the report, it was obtained by estimating the velocity from the waveform found in the tracing of the main PV by trained investigators. Sixteen subjects did not have calculated velocity by the sonographic machine; seven subjects with PVT and nine subjects without PVT.</p></section><section id="S9"><h3 class="pmc_sec_title">Statistical Analysis</h3> <p id="P10">Univariate analysis was performed using paired t-test and McNemar’s test for categorical and continuous variables as appropriate. Cox proportional hazards regression models were constructed to assess risk factors for the development of new PVT utilizing the c-statistic as a standard measure of the predictive accuracy of the model. Patient characteristics were included as adjustment variables in the conditional logistic regression analysis if they had meaningful unadjusted levels of association in the paired univariate analysis (statistically significant at p<0.20), were clinically important, or had been shown to be significant in prior studies (<a href="#R19" class="usa-link" aria-describedby="R19">19</a>, <a href="#R20" class="usa-link" aria-describedby="R20">20</a>). Receiver operating characteristic curves (ROC) were constructed to assess the sensitivity and specificity of baseline PV velocity in predicting PVT. Matched Kaplan Meier curves stratified based on PVT and PV velocity were constructed for overall and transplant-free survival utilizing the log-rank test to determine statistical significance (log rank ≤ 0.05). Additional Kaplan Meier curves were created with PVT as the event and stratified on PV velocity. All statistical tests for significance were two sided and a significance level p ≤0.05 was considered statistically significant. Data management and analyses were performed using SAS (version 9.4, Cary, NC). Stata version 13 (StataCorp LP, College Station, Texas) was used for graphic generation. Institutional review board approval was obtained from the University of Virginia Health Sciences Research Institutional Review Board. No data from prisoners were included in this study. Informed consent was not obtained from individual patients owing to the retrospective nature of our work.</p></section></section><section id="S10"><h2 class="pmc_sec_title">RESULTS</h2> <p id="P11">One hundred subjects with mean age 53.8 +/− 13.1 years and MELD score 14.9 +/− 5.5 met inclusion criteria, of which there were 50 paired cases with PVT and controls without PVT. Sixty-four percent of the cohort was male and 76% were CTP Class A or B. Chronic hepatitis C (HCV) was the leading cause of underlying liver disease in 31%. Non-alcoholic steatohepatitis (NASH) was the second leading etiology comprising 30%. Mean follow-up was 1,233 +/− 951 days. Twenty-one subjects underwent liver transplantation. One-year cohort overall survival was 87%, three-year 65% and five-year 59%. Transplant-free survival was 75% at one-year, 57% three-year and 34% five-year.</p> <p id="P12">Of the 50 subjects with PVT, 58% (n=39) were partial and 42% (n=21) were chronic. 8% (n=4) had cavernous transformation. Thirty-two involved the main PV, 28 the right and 26 the left. The superior mesenteric vein was involved in 14% (n=7) and no cases of clot extension or primary clot were found in the splenic vein. Ultrasound with hepatic Doppler diagnosed 42 cases whereas MRI was utilized in 16 and CT in seven. Thirty subjects eventually developing PVT had portal flow <15 cm/s (60%) on their index scan. Of the 36 patients with documented portal velocity at the time of PVT diagnosis, 27.8% (n=10) had a decrease from their baseline flow at study entry but on average, a 2.6 cm/s decrease in velocity was observed (median −1.0cm/s, IQR −9.1 to +4.0 cm/s). <a href="#T2" class="usa-link">Table 2</a> describes the characteristics of the PVT cases.</p> <section class="tw xbox font-sm" id="T2"><h3 class="obj_head">Table 2.</h3> <div class="caption p"><p>Characteristics of Portal Vein Thrombosis</p></div> <div class="tbl-box p" tabindex="0"><table class="content" frame="box" rules="all"> <thead><tr> <th valign="top" align="left" rowspan="1" colspan="1"></th> <th valign="top" align="left" rowspan="1" colspan="1">Number (n)</th> <th valign="top" align="left" rowspan="1" colspan="1">Percent (%)</th> </tr></thead> <tbody> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Acuity</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Partial</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">29</td> <td align="left" valign="top" rowspan="1" colspan="1">58.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Chronic</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">21</td> <td align="left" valign="top" rowspan="1" colspan="1">42.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Cavernoma</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">4</td> <td align="left" valign="top" rowspan="1" colspan="1">8.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Location</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Left PV</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">26</td> <td align="left" valign="top" rowspan="1" colspan="1">52.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Right PV</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">28</td> <td align="left" valign="top" rowspan="1" colspan="1">56.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Main PV</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">32</td> <td align="left" valign="top" rowspan="1" colspan="1">64.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Splenic vein</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">0</td> <td align="left" valign="top" rowspan="1" colspan="1">0.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Superior mesenteric vein</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">7</td> <td align="left" valign="top" rowspan="1" colspan="1">14.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Imaging modality</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>US with hepatic Doppler</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">42</td> <td align="left" valign="top" rowspan="1" colspan="1">84.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>CT scan</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">7</td> <td align="left" valign="top" rowspan="1" colspan="1">14.0</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>MRI scan</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">16</td> <td align="left" valign="top" rowspan="1" colspan="1">32.0</td> </tr> </tbody> </table></div> <div class="p text-right font-secondary"><a href="table/T2/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <div class="tw-foot p"> <div class="fn" id="TFN5"><p>CT=computed tomography; MRI=magnetic resonance imaging; PV=portal vein; US=ultrasound</p></div> <div class="fn" id="TFN6"> <sup>*</sup><p class="display-inline">36/42 patients had ultrasound velocities recorded at diagnosis of PVT</p> </div> </div></section><p id="P13">When comparing cases with PVT to controls without PVT at the time of index ultrasound, the two groups were very similar with some notable exceptions (<a href="#T1" class="usa-link">Table 1</a>). Baseline blood flow in the main PV was significantly lower in the PVT group (16.9 cm/s, 95% CI 13.9–20.0 cm/s vs. 25.0 cm/s, 95% CI 21.8–28.2 cm/s, p<0.001). Thirty subjects (60.0%) who eventually developed a PVT had portal blood flow <15 cm/s on their index ultrasound compared to 5 controls (10.0%), p<0.001 (<a href="#F1" class="usa-link">Figure 1</a>). MELD at the time of index ultrasound, age and gender were similar between the cases and the controls indicating appropriate matching, as was etiology of underlying liver disease, portal hypertensive complications and CTP Class. Twenty-six cases with PVT were prescribed non-selective beta blockade (NSBB) at the time of index ultrasound compared to 18 controls (p=0.11). Portal flow was slightly decreased in the subjects on NSBB (20.7 cm/s, 95% CI 16.6–24.9 vs. 21.1 cm/s, 95% CI 18.5–23.7, p = 0.88), however, response to NSBB was only able to be diagnosed in 41% of the cohort, of which 49% met the definition for adequate response defined as a baseline pulse reduction of ≥ 20%(<a href="#R21" class="usa-link" aria-describedby="R21">21</a>, <a href="#R22" class="usa-link" aria-describedby="R22">22</a>) [six out of 11 controls (54.5%) vs. two out of seven cases (28.6%), p=0.28]. Forty-eight patients included had cross-sectional imaging with CT or MRI scans that was able to discern the presence or absence of splenorenal shunts. 27.3% (n=9) of cases with available imaging had a splenorenal shunt compared to 26.7% (n=4) of controls.</p> <section class="tw xbox font-sm" id="T1"><h3 class="obj_head">Table 1.</h3> <div class="caption p"><p>Baseline characteristics</p></div> <div class="tbl-box p" tabindex="0"><table class="content" frame="box" rules="cols"> <thead> <tr> <th valign="top" align="left" rowspan="1" colspan="1"></th> <th valign="top" align="left" rowspan="1" colspan="1">Cases with PVT (n=50)</th> <th valign="top" align="left" rowspan="1" colspan="1">Controls without PVT (n=50)</th> </tr> <tr><th colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </th></tr> </thead> <tbody> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Demographics</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Age, mean years (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">54.5 (51.5–57.6)</td> <td align="left" valign="top" rowspan="1" colspan="1">53.1 (48.8–57.4)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Male gender, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">32 (64.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">32 (64.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>BMI, mean kg/m2 (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">28.6 (26.9–30.4)</td> <td align="left" valign="top" rowspan="1" colspan="1">30.4 (28.0–32.7)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Active smoking, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">15 (30.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">13 (26.5)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Active alcohol use, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">11 (22.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">8 (16.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Medical Comorbidities, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Diabetes</td> <td align="left" valign="top" rowspan="1" colspan="1">15 (30.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">19 (38.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Coronary artery disease</td> <td align="left" valign="top" rowspan="1" colspan="1">4 (8.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Hypertension</td> <td align="left" valign="top" rowspan="1" colspan="1">16 (32.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">14 (28.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Medications, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Anticoagulants</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">1 (2.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Aspirin</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Nonselective beta-blockade</td> <td align="left" valign="top" rowspan="1" colspan="1">26 (52.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">18 (36.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Diuretics</td> <td align="left" valign="top" rowspan="1" colspan="1">28 (56.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">31 (62.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Lactulose</td> <td align="left" valign="top" rowspan="1" colspan="1">12 (24.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">17 (34.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Rifaxamin</td> <td align="left" valign="top" rowspan="1" colspan="1">8 (16.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">8 (16.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Proton pump inhibitor</td> <td align="left" valign="top" rowspan="1" colspan="1">19 (38.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">20 (40.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Etiology of liver disease, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Alcoholic liver disease</td> <td align="left" valign="top" rowspan="1" colspan="1">9 (18.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">12 (24.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Autoimmune disease</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">1 (2.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Cholestatic disease</td> <td align="left" valign="top" rowspan="1" colspan="1">6 (12.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">3 (6.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Hepatitis B</td> <td align="left" valign="top" rowspan="1" colspan="1">1 (2.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">0 (0.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Hepatitis C</td> <td align="left" valign="top" rowspan="1" colspan="1">14 (28.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">17 (34.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> NASH</td> <td align="left" valign="top" rowspan="1" colspan="1">16 (32.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">14 (28.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> Other</td> <td align="left" valign="top" rowspan="1" colspan="1">2 (8.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">3 (6.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Severity of Liver Disease</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>MELD score, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">14.6 (13.0–16.2)</td> <td align="left" valign="top" rowspan="1" colspan="1">15.1 (13.6–16.7)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>CTP class, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>A</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">12 (24.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">10 (20.0)</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>B</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">26 (52.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">28 (56.0)</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>C</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">12 (24.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">12 (24.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>HCC, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">2 (4.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">0 (0.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Ascites, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">30 (60.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">31 (62.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Gastroesophageal varices, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">27 (54.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">24 (48.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Hepatic encephalopathy, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">18 (36.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">20 (40.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Laboratory values</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Serum bilirubin, mg/dL, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">3.3 (2.0–4.5)</td> <td align="left" valign="top" rowspan="1" colspan="1">3.3 (1.8–4.9)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>INR, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">1.47 (1.32–1.63)</td> <td align="left" valign="top" rowspan="1" colspan="1">1.45 (1.37–1.52)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Serum albumin, g/dL, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">3.3 (3.1–3.6)</td> <td align="left" valign="top" rowspan="1" colspan="1">3.1 (2.9–3.3)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Creatinine, g/dL, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">0.97 (0.84–1.09)</td> <td align="left" valign="top" rowspan="1" colspan="1">1.04 (0.89–1.19)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Serum sodium, mEq/L, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">137.0 (136.0–138.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">136.1 (134.6–137.6)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Alanine aminotransferase, Units/L, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">82.3 (24.3–140.2)</td> <td align="left" valign="top" rowspan="1" colspan="1">58.8 (38.1–79.5)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Aspartate aminotransferase, Units/L, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">107.3 (59.6–154.9)</td> <td align="left" valign="top" rowspan="1" colspan="1">85.9 (58.3–113.6)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Blood urea nitrogen, mg/dL, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">16.6 (13.3–19.9)</td> <td align="left" valign="top" rowspan="1" colspan="1">17.6 (13.0–22.2)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Serum alkaline phosphatase, Units/L, mean (95% CI)</strong> <a href="#TFN1" class="usa-link"><sup>*</sup></a> </td> <td align="left" valign="top" rowspan="1" colspan="1">143.2 (118.0–160.3)</td> <td align="left" valign="top" rowspan="1" colspan="1">190.9 (161.0–220.7)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Platelet count, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">95.4 (73.6–117.2)</td> <td align="left" valign="top" rowspan="1" colspan="1">111.6 (92.6–130.6)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Mean platelet volume, fL, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">11.4 (10.7–12.2)</td> <td align="left" valign="top" rowspan="1" colspan="1">11.4 (10.8–12.0)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Portal vein characteristics</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1"></td> <td align="left" valign="top" rowspan="1" colspan="1"></td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Main portal vein velocity, mean cm/s (95% CI)</strong> <a href="#TFN3" class="usa-link"><sup>***</sup></a> </td> <td align="left" valign="top" rowspan="1" colspan="1">16.9 (13.9–20.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">25.0 (21.8–28.2)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Main portal vein diameter, cm (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">1.32 (1.04–1.61)</td> <td align="left" valign="top" rowspan="1" colspan="1">1.20 (0.57–1.82)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Splenorenal shunt, n (%)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">9 (27.3)</td> <td align="left" valign="top" rowspan="1" colspan="1">4 (26.7)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Splenic thickness, cm, mean (95% CI)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">15.2 (13.5–16.9)</td> <td align="left" valign="top" rowspan="1" colspan="1">15.1 (8.4–21.7)</td> </tr> <tr><td colspan="3" valign="bottom" align="left" rowspan="1"> <hr> </td></tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Portal vein blood flow <15 cm/s, n (%)</strong> <a href="#TFN3" class="usa-link"><sup>***</sup></a> </td> <td align="left" valign="top" rowspan="1" colspan="1">30 (60.0)</td> <td align="left" valign="top" rowspan="1" colspan="1">5 (10.0)</td> </tr> </tbody> </table></div> <div class="p text-right font-secondary"><a href="table/T1/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <div class="tw-foot p"> <div class="fn" id="TFN1"> <sup>*</sup><p class="display-inline">=P < 0.05</p> </div> <div class="fn" id="TFN2"> <sup>**</sup><p class="display-inline">=P < 0.01</p> </div> <div class="fn" id="TFN3"> <sup>***</sup><p class="display-inline">=P < 0.001</p> </div> <div class="fn" id="TFN4"><p>BMI=Body mass index; CI=Confidence interval; CTP= Child Turcotte Pugh; HCC=Hepatocellular carcinoma; INR=International normalized ratio; NASH=Non-alcoholic steatohepatitis; NS=Not significant (p≥ 0.05); PVT=Portal vein thrombosis</p></div> </div></section><figure class="fig xbox font-sm" id="F1"><h3 class="obj_head">Figure 1. Rate of PVT is dependent on portal vein flow.</h3> <p class="img-box line-height-none margin-x-neg-2 tablet:margin-x-0 text-center"><a class="tileshop" target="_blank" href="https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=10540634_nihms886108f1.jpg"><img class="graphic zoom-in" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9d8/10540634/1b07a72ca73c/nihms886108f1.jpg" loading="lazy" height="604" width="800" alt="Figure 1"></a></p> <div class="p text-right font-secondary"><a href="figure/F1/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <figcaption><p>Portal vein velocity is associated with future portal vein thrombosis development in a dose-dependent fashion with the highest frequency observed in patients with velocity <15 cm/second</p></figcaption></figure><p id="P14">Twelve cases with PVT (24%) were prescribed anticoagulation in either therapeutic or prophylactic dosing. Two received apixaban (2.5 mg twice a day), three rivaroxaban (one 10 mg/day, two 20 mg/day), five low molecular weight heparin (1mg/kg twice daily) and two warfarin (goal INR 2–3). Ten patients had follow-up imaging six months after the diagnosis of PVT of which 70% had either partial (defined as improvement in clot burden and partial recanalization of the portal vein) or complete response to treatment (complete recanalization of the portal vein). Four cases achieved partial recanalization (three rivaroxaban and one low molecular weight heparin) and three obtained complete clot resolution (one apixaban and two low molecular weight heparin). No patients were prescribed therapeutic anticoagulation for treatment indications other than PVT. Four cases had either an inherited or acquired abnormality in hemostasis; one factor V Leiden heterozygote, two with low levels of antithrombin III and four were protein C deficient. No controls underwent testing for inherited or acquired abnormality in hemostasis.</p> <p id="P15">Thirteen cases (26%) died during the follow-up period compared to 6 controls (12%). Five cases (10%) with PVT underwent liver transplantation compared to 16 controls (32%) without PVT. 4 cases (80%) had PVT on direct explant examination at the time of liver transplantation. Mean follow-up was similar between the two groups with 1,175 days (95% CI 912–1439 days) for the controls and 1,290 days (95% CI 1,012–1,568) for PVT cases (p=0.549).</p> <p id="P16">On adjusted multivariable analysis, portal flow on the index scan was the strongest independent risk factor predicting eventual PVT development within 12 months (HR 0.86, 95% CI 0.80–0.93) (<a href="#T3" class="usa-link">Table 3</a>). Area under the receiver operator curve (ROC) was greatest for flow < 15 cm/s (c statistic 0.77). ROC AUC was 0.72 for flow <20 cm/s and 0.55 for flow <10 cm/s. Sensitivity and specificity for portal flow <15 cm was 78% and 72% respectively. Negative predictive value was 74%. For portal flow <15 cm/s, the HR for eventual development of PVT on adjusted multivariable analysis was 6.00 (95% CI 2.20–16.40, p<0.001). For each cm/s the portal velocity drops below 15, the risk of PVT increases six fold. Fifteen patients (43%) with portal velocity <15cm/s developed PVT within 12 months versus eight patients (12.3%) with portal velocity ≥ 15cm/s (p<0.001). Subjects with underlying NASH cirrhosis were also at increased risk for PVT development (HR 5.34, 95% CI 1.53–18.66, p=0.009) while BMI was inversely related to future PVT (HR 0.86, 95% CI 0.79–0.95, p=0.002).</p> <section class="tw xbox font-sm" id="T3"><h3 class="obj_head">Table 3.</h3> <div class="caption p"><p>Adjusted multivariable cox proportional hazards regression analysis for predictors of <em>de novo</em> portal vein thrombosis</p></div> <div class="tbl-box p" tabindex="0"><table class="content" frame="box" rules="all"> <thead><tr> <th valign="top" align="left" rowspan="1" colspan="1"></th> <th valign="top" align="left" rowspan="1" colspan="1">Hazards Ratio</th> <th valign="top" align="left" rowspan="1" colspan="1">95% CI</th> <th valign="top" align="left" rowspan="1" colspan="1">p value</th> </tr></thead> <tbody> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Portal velocity <15 cm/s</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">6.00</td> <td align="left" valign="top" rowspan="1" colspan="1">2.20–16.40</td> <td align="left" valign="top" rowspan="1" colspan="1"><0.001</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Albumin, g/dL</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">0.74</td> <td align="left" valign="top" rowspan="1" colspan="1">0.38–1.48</td> <td align="left" valign="top" rowspan="1" colspan="1">NS</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Platelet count</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">1.00</td> <td align="left" valign="top" rowspan="1" colspan="1">0.99–1.01</td> <td align="left" valign="top" rowspan="1" colspan="1">NS</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Hepatitis C</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">1.35</td> <td align="left" valign="top" rowspan="1" colspan="1">0.48–3.81</td> <td align="left" valign="top" rowspan="1" colspan="1">NS</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>PPI</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">0.49</td> <td align="left" valign="top" rowspan="1" colspan="1">0.22–1.12</td> <td align="left" valign="top" rowspan="1" colspan="1">NS</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>NASH</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">5.34</td> <td align="left" valign="top" rowspan="1" colspan="1">1.53–18.66</td> <td align="left" valign="top" rowspan="1" colspan="1">0.009</td> </tr> <tr> <td align="left" valign="top" rowspan="1" colspan="1"> <strong>Body mass index (kg/m2)</strong> </td> <td align="left" valign="top" rowspan="1" colspan="1">0.86</td> <td align="left" valign="top" rowspan="1" colspan="1">0.79–0.95</td> <td align="left" valign="top" rowspan="1" colspan="1">0.002</td> </tr> </tbody> </table></div> <div class="p text-right font-secondary"><a href="table/T3/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <div class="tw-foot p"><div class="fn" id="TFN7"><p>NASH= nonalcoholic steatohepatitis; PPI= proton pump inhibitor</p></div></div></section><p id="P17">Matched Kaplan-Meier survival curves were constructed to model overall, transplant free survival and time to PVT development. Median time to PVT development was 379 days. Time to PVT development was significantly different when stratified by PV flow (<a href="#F2" class="usa-link">Figure 2</a>). No significant difference was seen when comparing cases to controls with respect to one, three and five-year overall and transplant free survival (<a href="#F3" class="usa-link">Figure 3</a>). No difference was seen when stratifying portal blood flow to those <15 cm/s versus ≥ 15cm/s in one, three and five-year overall and transplant-free survival (<a href="#F4" class="usa-link">Figure 4</a>) however the curves did diverge towards the end of the follow-up period approaching statistical significance for transplant-free survival.</p> <figure class="fig xbox font-sm" id="F2"><h3 class="obj_head">Figure 2. Matched Kaplan Meier Curve for Time-to-PVT Development Stratified by Portal Vein Velocity.</h3> <p class="img-box line-height-none margin-x-neg-2 tablet:margin-x-0 text-center"><img class="graphic" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9d8/10540634/d2db6336aaee/nihms886108f2.jpg" loading="lazy" height="540" width="714" alt="Figure 2"></p> <div class="p text-right font-secondary"><a href="figure/F2/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <figcaption><p>Portal vein velocity <15cm/s is predictive of future portal vein thrombosis development</p></figcaption></figure><figure class="fig xbox font-sm" id="F3"><h3 class="obj_head">Figure 3. Kaplan Meier Overall and Transplant-free Survival Curve Stratified by portal vein flow.</h3> <p class="img-box line-height-none margin-x-neg-2 tablet:margin-x-0 text-center"><img class="graphic" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9d8/10540634/f4edf3c961cd/nihms886108f3.jpg" loading="lazy" height="323" width="800" alt="Figure 3"></p> <div class="p text-right font-secondary"><a href="figure/F3/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <figcaption><p>(a)No differences were observed in overall survival when stratifying on portal vein velocity</p> <p>(b)Portal vein velocity as not associated with differing transplant free survival rates</p></figcaption></figure><figure class="fig xbox font-sm" id="F4"><h3 class="obj_head">Figure 4. Kaplan Meier Overall and Transplant-free Survival Curve Stratified by portal vein thrombosis.</h3> <p class="img-box line-height-none margin-x-neg-2 tablet:margin-x-0 text-center"><a class="tileshop" target="_blank" href="https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=10540634_nihms886108f4.jpg"><img class="graphic zoom-in" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9d8/10540634/99445c45fdbe/nihms886108f4.jpg" loading="lazy" height="228" width="606" alt="Figure 4"></a></p> <div class="p text-right font-secondary"><a href="figure/F4/" class="usa-link" target="_blank" rel="noopener noreferrer">Open in a new tab</a></div> <figcaption><p>(a) Overall survival was similar in patients with and without portal vein thrombosis</p> <p>(b) Transplant free survival was similar in patients with and without portal vein thrombosis</p></figcaption></figure></section><section id="S11"><h2 class="pmc_sec_title">DISCUSSION</h2> <p id="P18">This study confirms the inverse relationship between PV flow and PVT incidence in cirrhosis patients and suggests a possible method to risk stratify patients that may be at higher risk to develop PVT. The major strength of this study is the use of matched case-control methodology, which allows for control of multiple confounding factors associated with portal blood flow. In this cohort, decreased PV flow was significantly associated with increased odds of PVT development when adjusting for other associated factors. PV flow rates <15 cm/s are sensitive for discerning which patients with cirrhosis are at risk for developing future PVT and display an excellent negative predictive value. Based on this cutoff, color Doppler ultrasound to determine portal blood flow should be considered a potential screening tool for identifying those at highest thrombotic risk.</p> <p id="P19">The development of <em>de novo</em> PVT, while multifactorial, is due to the synergistic interaction of vessel wall and endothelial injury,(<a href="#R23" class="usa-link" aria-describedby="R23">23</a>) local factors contributing to hypercoagulability,(<a href="#R24" class="usa-link" aria-describedby="R24">24</a>, <a href="#R25" class="usa-link" aria-describedby="R25">25</a>) and blood flow stasis from portal hypertension. Through increasing the time that blood resides in the large vessels of the mesenteric system, there is presumptive disruption of the physiologic systems in place for regulating coagulation in the microcirculation.(<a href="#R13" class="usa-link" aria-describedby="R13">13</a>) Any alteration in hemodynamics in the hepatic parenchyma, including PVT, which disrupts the delicate balance of inflow and outflow, can lead to hepatocyte ischemia and hormonal deprivation.(<a href="#R3" class="usa-link" aria-describedby="R3">3</a>, <a href="#R26" class="usa-link" aria-describedby="R26">26</a>) The resultant hepatocyte death may lead to tissue atrophy, also known as parenchymal extinction, and ultimately worsening of hepatic fibrosis.(<a href="#R3" class="usa-link" aria-describedby="R3">3</a>)</p> <p id="P20">The majority of our cases with PVT were not prescribed anticoagulation following their diagnosis. Of the 12 patients receiving anticoagulation, 58% achieved either a partial or a complete response by six months and factor Xa inhibitor therapy alone was successful in 83% of cases. These outcomes are promising but should be interpreted with caution due to small sample size and significant heterogeneity in medication dosing and duration. Further prospective study is necessary to confirm the best therapy for PVT.</p> <p id="P21">Whether or not prophylactic intervention in the high-risk group with low portal flow is beneficial remains to be determined. Notably, Villa <em>et al</em> found daily prophylactic dosing of low molecular weight heparin for 12 months prevented development of <em>de novo</em> PVT in patients with compensated cirrhosis.(<a href="#R27" class="usa-link" aria-describedby="R27">27</a>) This has important clinical implications as the authors demonstrated striking differences in hepatic decompensation reduction in the low molecular weight heparin arm with a resultant survival benefit. The findings of the current study reveal an intriguing avenue for future study to aim prophylactic therapy at a potentially higher risk group. Future therapeutic studies should consider focusing on cohorts with slower flow that are higher risk to develop PVT.</p> <p id="P22">Contrary to previous reports, (<a href="#R28" class="usa-link" aria-describedby="R28">28</a>) we did not find a significant association between thrombocytopenia and PVT. Hypoalbuminemia, which has been described as a predictor of thrombotic risk in hospitalized patients with cirrhosis,(<a href="#R29" class="usa-link" aria-describedby="R29">29</a>) was also not associated with a higher odds of PVT. As both thrombocytopenia and hypoalbuminemia can be considered markers of advanced liver disease, our matching by MELD score controlled for liver disease severity in order to avoid confounding with the primary outcome and may offer an explanation to the lack of confirmation of these previous findings. NSBB also did not increase the odds of future PVT development nor did we find statistically or clinically significant differences in baseline portal blood flow despite well-established evidence that NSBB decreases portal flow.(<a href="#R30" class="usa-link" aria-describedby="R30">30</a>, <a href="#R31" class="usa-link" aria-describedby="R31">31</a>) Our study was likely underpowered to fully investigate the effects of NSBB given that only 44% of the cohort was prescribed a NSBB at the time of index ultrasound.</p> <p id="P23">We did confirm our previous findings based on cross-sectional analysis of the UNOS/OPTN database(<a href="#R32" class="usa-link" aria-describedby="R32">32</a>, <a href="#R33" class="usa-link" aria-describedby="R33">33</a>) that subjects with NASH cirrhosis are a high-risk population for PVT development and that NASH is a thrombophilic state. Interestingly, this finding was independent of BMI. In fact, BMI was inversely related to <em>de novo</em> PVT formation, perhaps owing to the fact that BMI is an inaccurate measure of metabolic risk in cirrhosis patients with ascites as 60% of our cohort had ascites.</p> <p id="P24">Our study has several limitations. While outcomes were captured for subjects who did not undergo transplantation, we did not examine outcomes in the subgroup that went on to receive an organ. Our study was underpowered to investigate survival precisely, although there was a trend towards significance when stratifying by PV flow. Complete investigation of the role of spontaneous portosystemic shunts, in particular splenorenal shunts, was also underpowered due to the low numbers of patients (<30%) with available cross-sectional vascular imaging. Thrombophilia testing was not performed in the majority of patients enrolled before 2010 with PVT and in no patients without PVT thus concrete conclusions could not be made about this, however, the 4% prevalence of inherited thrombophilia is similar to a recent meta-analysis of 9 studies that showed a pooled prevalence ranging between 2.9–5.6%.(<a href="#R34" class="usa-link" aria-describedby="R34">34</a>) Standardized outcome assessment in all cases with PVT with six-month ultrasound was also underreported and often not checked in patients with PVT who were not started on anticoagulation, often due to impending mortality. The majority of subjects excluded from our analysis had ultrasounds at referring institutions which were not readily available to review and confirm portal velocity, which in part explains the low event rate of PVT over the ten-year study period, however we attempted to control for differences in ultrasound measurements by matching cases and controls on time within 30-days at enrollment to ensure similar techniques were utilized and allow for intra-pair reliability.</p> <p id="P25">In conclusion, decreased PV velocity is associated with significantly increased risk for the development of PVT within 12 months of index ultrasound and a trend towards lower transplant free survival. Detection of PV flow below 15 cm/s is highly sensitive for predicting future PVT risk. Future prospective studies should seek to expand the knowledge of associated risk factors and investigate the potential role of thromboprophylaxis for prevention of PVT in this high-risk group.</p></section><section id="floats-group1" class="floats-group"><section class="bt xbox font-sm" id="BX1"><h2 class="obj_head">KEY POINTS.</h2> <ul id="L1" class="list" style="list-style-type:disc"> <li><p id="P26">Portal vein thrombosis in cirrhosis may lead to hepatic decompensation and increased mortality</p></li> <li><p id="P27">Risk factors for portal vein thrombosis development remain under investigation.</p></li> <li><p id="P28">On adjusted multivariable analysis, portal vein velocity was the strongest independent risk factor predicting portal vein thrombosis development.</p></li> <li><p id="P29">Portal vein velocity <15cm/s places patients at high-risk for developing future portal vein thrombosis independent of other well-described risk factors and may offer an avenue for future interventional study in this at-risk population</p></li> </ul></section></section><section id="S13" class="ack"><h2 class="pmc_sec_title">Acknowledgments</h2> <p><strong>Grant support:</strong> This work was supported in part by grant funding from the National Institutes of Health (Grant 5T32DK007769-15) and National Institutes of Health Grant Surgical Oncology T32 CA163177</p> <p>The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.</p> <p>This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.</p> <p>We would like to thank Dennis Kumral, MD for his assistance with data acquisition.</p></section><section id="GL" class="glossary"><h2 class="pmc_sec_title">Abbreviations</h2> <dl class="def-list"> <dt id="G1">CT</dt> <dd><p>computed tomography</p></dd> <dt id="G2">CTP</dt> <dd><p>Child Turcotte Pugh</p></dd> <dt id="G3">HCC</dt> <dd><p>hepatocellular carcinoma</p></dd> <dt id="G4">HCV</dt> <dd><p>hepatitis C</p></dd> <dt id="G5">MELD</dt> <dd><p>model for end-stage liver disease</p></dd> <dt id="G6">MRI</dt> <dd><p>magnetic resonance imaging</p></dd> <dt id="G7">NASH</dt> <dd><p>nonalcoholic steatohepatitis</p></dd> <dt id="G8">NSBB</dt> <dd><p>nonselective beta blocker</p></dd> <dt id="G9">OR</dt> <dd><p>odds ratio</p></dd> <dt id="G10">PV</dt> <dd><p>portal vein</p></dd> <dt id="G11">PVT</dt> <dd><p>portal vein thrombosis</p></dd> <dt id="G12">ROC</dt> <dd><p>receiver operator curve</p></dd> <dt id="G13">TIPS</dt> <dd><p>transjugular intrahepatic portosystemic shunt</p></dd> </dl></section><section id="fn-group1" class="fn-group"><h2 class="pmc_sec_title">Footnotes</h2> <div class="fn-group p font-secondary-light font-sm"> <div class="fn p" id="FN2"><p><strong>Disclosures:</strong> The authors of this manuscript have no conflicts of interest to disclose.</p></div> <div class="fn p" id="FN3"> <p><strong>Authorship statement:</strong> All authors participated in the listed roles below.</p> <p>JS- planning/conducting study, collecting and/or interpreting data, drafting manuscript, final approval</p> <p>JW- collecting data, drafting manuscript, final approval</p> <p>PM- collecting and/or interpreting data, drafting manuscript, final approval</p> <p>NI- drafting manuscript, final approval</p> <p>CA- drafting manuscript, final approval</p> <p>AU- collecting and/or interpreting data, drafting manuscript, final approval</p> <p>SC- drafting manuscript, final approval</p> <p>PN- planning/conducting study, collecting and/or interpreting data, drafting manuscript, final approval</p> </div> </div></section><section id="_ci93_" lang="en" class="contrib-info"><h2 class="pmc_sec_title">Contributor Information</h2> <p>Jonathan G. Stine, Email: jgs9f@virginia.edu.</p> <p>Jennifer Wang, Email: jw4yx@virginia.edu.</p> <p>Puja M. Shah, Email: ps5au@virginia.edu.</p> <p>Curtis K. Argo, Email: cka3d@virginia.edu.</p> <p>Nicolas Intagliata, Email: nmi4d@virginia.edu.</p> <p>Andre Uflacker, Email: au2b@virginia.edu.</p> <p>Stephen H. Caldwell, Email: shc5c@virginia.edu.</p> <p>Patrick G. Northup, Email: northup@virginia.edu.</p></section><section id="ref-list1" class="ref-list"><h2 class="pmc_sec_title">References</h2> <section id="ref-list1_sec2"><ul class="ref-list font-sm" style="list-style-type:none"> <li id="R1"> <span class="label">1.</span><cite>Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69:1873–81. doi: 10.1097/00007890-200005150-00023.</cite> [<a href="https://doi.org/10.1097/00007890-200005150-00023" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10830225/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Transplantation&title=Portal%20vein%20thrombosis%20in%20adults%20undergoing%20liver%20transplantation:%20risk%20factors,%20screening,%20management,%20and%20outcome&author=MA%20Yerdel&author=B%20Gunson&author=D%20Mirza&volume=69&publication_year=2000&pages=1873-81&pmid=10830225&doi=10.1097/00007890-200005150-00023&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R2"> <span class="label">2.</span><cite>DeLeve LD, Valla DC, Garcia-Tsao G. Vascular disorders of the liver. Hepatology. 2009;49:1729–64. doi: 10.1002/hep.22772.</cite> [<a href="https://doi.org/10.1002/hep.22772" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC6697263/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19399912/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=Vascular%20disorders%20of%20the%20liver&author=LD%20DeLeve&author=DC%20Valla&author=G%20Garcia-Tsao&volume=49&publication_year=2009&pages=1729-64&pmid=19399912&doi=10.1002/hep.22772&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R3"> <span class="label">3.</span><cite>Wanless IR, Wong F, Blendis LM, et al. Hepatic and portal vein thrombosis in cirrhosis: possible role in development of parenchymal extinction and portal hypertension. Hepatology (Baltimore, Md) 1995;21:1238–1247.</cite> [<a href="https://pubmed.ncbi.nlm.nih.gov/7737629/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology%20(Baltimore,%20Md)&title=Hepatic%20and%20portal%20vein%20thrombosis%20in%20cirrhosis:%20possible%20role%20in%20development%20of%20parenchymal%20extinction%20and%20portal%20hypertension&author=IR%20Wanless&author=F%20Wong&author=LM%20Blendis&volume=21&publication_year=1995&pages=1238-1247&pmid=7737629&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R4"> <span class="label">4.</span><cite>Okuda K, Ohnishi K, Kimura K, et al. Incidence of portal vein thrombosis in liver cirrhosis. An angiographic study in 708 patients. Gastroenterology. 1985;89:279–86. doi: 10.1016/0016-5085(85)90327-0.</cite> [<a href="https://doi.org/10.1016/0016-5085(85)90327-0" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/4007419/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Gastroenterology&title=Incidence%20of%20portal%20vein%20thrombosis%20in%20liver%20cirrhosis.%20An%20angiographic%20study%20in%20708%20patients&author=K%20Okuda&author=K%20Ohnishi&author=K%20Kimura&volume=89&publication_year=1985&pages=279-86&pmid=4007419&doi=10.1016/0016-5085(85)90327-0&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R5"> <span class="label">5.</span><cite>Englesbe MJ, Kubus J, Muhammad W, et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2010;16:83–90. doi: 10.1002/lt.21941.</cite> [<a href="https://doi.org/10.1002/lt.21941" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20035521/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Liver%20Transplantation%20:%20official%20publication%20of%20the%20American%20Association%20for%20the%20Study%20of%20Liver%20Diseases%20and%20the%20International%20Liver%20Transplantation%20Society&title=Portal%20vein%20thrombosis%20and%20survival%20in%20patients%20with%20cirrhosis&author=MJ%20Englesbe&author=J%20Kubus&author=W%20Muhammad&volume=16&publication_year=2010&pages=83-90&pmid=20035521&doi=10.1002/lt.21941&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R6"> <span class="label">6.</span><cite>Rodriguez-Castro KI, Porte RJ, Nadal E, et al. Management of nonneoplastic portal vein thrombosis in the setting of liver transplantation: a systematic review. Transplantation. 2012;94:1145–1153. doi: 10.1097/TP.0b013e31826e8e53.</cite> [<a href="https://doi.org/10.1097/TP.0b013e31826e8e53" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23128996/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Transplantation&title=Management%20of%20nonneoplastic%20portal%20vein%20thrombosis%20in%20the%20setting%20of%20liver%20transplantation:%20a%20systematic%20review&author=KI%20Rodriguez-Castro&author=RJ%20Porte&author=E%20Nadal&volume=94&publication_year=2012&pages=1145-1153&pmid=23128996&doi=10.1097/TP.0b013e31826e8e53&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R7"> <span class="label">7.</span><cite>Hibi T, Nishida S, Levi DM, et al. When and Why Portal Vein Thrombosis Matters in Liver Transplantation: A Critical Audit of 174 Cases. Annals of Surgery. 2013 doi: 10.1097/SLA.0000000000000252.</cite> [<a href="https://doi.org/10.1097/SLA.0000000000000252" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24299686/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Annals%20of%20Surgery&title=When%20and%20Why%20Portal%20Vein%20Thrombosis%20Matters%20in%20Liver%20Transplantation:%20A%20Critical%20Audit%20of%20174%20Cases&author=T%20Hibi&author=S%20Nishida&author=DM%20Levi&publication_year=2013&pmid=24299686&doi=10.1097/SLA.0000000000000252&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R8"> <span class="label">8.</span><cite>Ponziani FR, Zocco MA, Senzolo M, et al. Portal vein thrombosis and liver transplantation: Implications for waiting list period, surgical approach, early and late follow-up. Transplant Rev (Orlando) 2014;28:92–101. doi: 10.1016/j.trre.2014.01.003.</cite> [<a href="https://doi.org/10.1016/j.trre.2014.01.003" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24582320/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Transplant%20Rev%20(Orlando)&title=Portal%20vein%20thrombosis%20and%20liver%20transplantation:%20Implications%20for%20waiting%20list%20period,%20surgical%20approach,%20early%20and%20late%20follow-up&author=FR%20Ponziani&author=MA%20Zocco&author=M%20Senzolo&volume=28&publication_year=2014&pages=92-101&pmid=24582320&doi=10.1016/j.trre.2014.01.003&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R9"> <span class="label">9.</span><cite>Stine JG. Portal vein thrombosis, mortality and hepatic decompensation in patients with cirrhosis: A meta-analysis. World J Hepatol. 2015 doi: 10.4254/wjh.v7.i27.2774. In press, accepted November 2015.</cite> [<a href="https://doi.org/10.4254/wjh.v7.i27.2774" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC4663397/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26644821/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=World%20J%20Hepatol&title=Portal%20vein%20thrombosis,%20mortality%20and%20hepatic%20decompensation%20in%20patients%20with%20cirrhosis:%20A%20meta-analysis&author=JG%20Stine&publication_year=2015&pmid=26644821&doi=10.4254/wjh.v7.i27.2774&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R10"> <span class="label">10.</span><cite>Stine JG. Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipients. HPB. 2015;2015 doi: 10.1016/j.hpb.2015.10.008. in press, epub Dec 9 2015.</cite> [<a href="https://doi.org/10.1016/j.hpb.2015.10.008" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC4814623/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27017168/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=HPB&title=Pre-transplant%20portal%20vein%20thrombosis%20is%20an%20independent%20risk%20factor%20for%20graft%20loss%20due%20to%20hepatic%20artery%20thrombosis%20in%20liver%20transplant%20recipients&author=JG%20Stine&volume=2015&publication_year=2015&pmid=27017168&doi=10.1016/j.hpb.2015.10.008&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R11"> <span class="label">11.</span><cite>Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: Results of a longitudinal study. Hepatology. 2015;61:660–7. doi: 10.1002/hep.27546.</cite> [<a href="https://doi.org/10.1002/hep.27546" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25284616/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=Causes%20and%20consequences%20of%20portal%20vein%20thrombosis%20in%201,243%20patients%20with%20cirrhosis:%20Results%20of%20a%20longitudinal%20study&author=F%20Nery&author=S%20Chevret&author=B%20Condat&volume=61&publication_year=2015&pages=660-7&pmid=25284616&doi=10.1002/hep.27546&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R12"> <span class="label">12.</span><cite>Berry K, Taylor J, Liou IW, et al. Portal Vein Thrombosis Is Not Associated With Increased Mortality Among Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2014 doi: 10.1016/j.cgh.2014.10.010.</cite> [<a href="https://doi.org/10.1016/j.cgh.2014.10.010" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25459555/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Clin%20Gastroenterol%20Hepatol&title=Portal%20Vein%20Thrombosis%20Is%20Not%20Associated%20With%20Increased%20Mortality%20Among%20Patients%20With%20Cirrhosis&author=K%20Berry&author=J%20Taylor&author=IW%20Liou&publication_year=2014&pmid=25459555&doi=10.1016/j.cgh.2014.10.010&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R13"> <span class="label">13.</span><cite>Zocco MA, Di Stasio E, De Cristofaro R, et al. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. Journal of hepatology. 2009;51:682–689. doi: 10.1016/j.jhep.2009.03.013.</cite> [<a href="https://doi.org/10.1016/j.jhep.2009.03.013" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19464747/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Journal%20of%20hepatology&title=Thrombotic%20risk%20factors%20in%20patients%20with%20liver%20cirrhosis:%20correlation%20with%20MELD%20scoring%20system%20and%20portal%20vein%20thrombosis%20development&author=MA%20Zocco&author=E%20Di%20Stasio&author=R%20De%20Cristofaro&volume=51&publication_year=2009&pages=682-689&pmid=19464747&doi=10.1016/j.jhep.2009.03.013&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R14"> <span class="label">14.</span><cite>Zironi G, Gaiani S, Fenyves D, et al. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension. J Hepatol. 1992;16:298–303. doi: 10.1016/s0168-8278(05)80660-9.</cite> [<a href="https://doi.org/10.1016/s0168-8278(05)80660-9" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1487606/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=J%20Hepatol&title=Value%20of%20measurement%20of%20mean%20portal%20flow%20velocity%20by%20Doppler%20flowmetry%20in%20the%20diagnosis%20of%20portal%20hypertension&author=G%20Zironi&author=S%20Gaiani&author=D%20Fenyves&volume=16&publication_year=1992&pages=298-303&pmid=1487606&doi=10.1016/s0168-8278(05)80660-9&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R15"> <span class="label">15.</span><cite>Zoli M, Iervese T, Merkel C, et al. Prognostic significance of portal hemodynamics in patients with compensated cirrhosis. J Hepatol. 1993;17:56–61. doi: 10.1016/s0168-8278(05)80521-5.</cite> [<a href="https://doi.org/10.1016/s0168-8278(05)80521-5" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8445220/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=J%20Hepatol&title=Prognostic%20significance%20of%20portal%20hemodynamics%20in%20patients%20with%20compensated%20cirrhosis&author=M%20Zoli&author=T%20Iervese&author=C%20Merkel&volume=17&publication_year=1993&pages=56-61&pmid=8445220&doi=10.1016/s0168-8278(05)80521-5&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R16"> <span class="label">16.</span><cite>Tallon Aguilar L, Jimenez Riera G, Suarez Artacho G, et al. Posttransplantation portal thrombosis secondary to splenorenal shunt persistence. Transplant Proc. 2010;42:3169–70. doi: 10.1016/j.transproceed.2010.05.075.</cite> [<a href="https://doi.org/10.1016/j.transproceed.2010.05.075" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20970639/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Transplant%20Proc&title=Posttransplantation%20portal%20thrombosis%20secondary%20to%20splenorenal%20shunt%20persistence&author=L%20Tallon%20Aguilar&author=G%20Jimenez%20Riera&author=G%20Suarez%20Artacho&volume=42&publication_year=2010&pages=3169-70&pmid=20970639&doi=10.1016/j.transproceed.2010.05.075&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R17"> <span class="label">17.</span><cite>Maruyama H, Okugawa H, Takahashi M, et al. De novo portal vein thrombosis in virus-related cirrhosis: predictive factors and long-term outcomes. The American Journal of Gastroenterology. 2013;108:568–574. doi: 10.1038/ajg.2012.452.</cite> [<a href="https://doi.org/10.1038/ajg.2012.452" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23381015/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=The%20American%20Journal%20of%20Gastroenterology&title=De%20novo%20portal%20vein%20thrombosis%20in%20virus-related%20cirrhosis:%20predictive%20factors%20and%20long-term%20outcomes&author=H%20Maruyama&author=H%20Okugawa&author=M%20Takahashi&volume=108&publication_year=2013&pages=568-574&pmid=23381015&doi=10.1038/ajg.2012.452&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R18"> <span class="label">18.</span><cite>Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70. doi: 10.1053/jhep.2001.22172.</cite> [<a href="https://doi.org/10.1053/jhep.2001.22172" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11172350/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=A%20model%20to%20predict%20survival%20in%20patients%20with%20end-stage%20liver%20disease&author=PS%20Kamath&author=RH%20Wiesner&author=M%20Malinchoc&volume=33&publication_year=2001&pages=464-70&pmid=11172350&doi=10.1053/jhep.2001.22172&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R19"> <span class="label">19.</span><cite>Bursac Z, Gauss CH, Williams DK, et al. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17. doi: 10.1186/1751-0473-3-17.</cite> [<a href="https://doi.org/10.1186/1751-0473-3-17" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC2633005/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19087314/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Source%20Code%20Biol%20Med&title=Purposeful%20selection%20of%20variables%20in%20logistic%20regression&author=Z%20Bursac&author=CH%20Gauss&author=DK%20Williams&volume=3&publication_year=2008&pages=17&pmid=19087314&doi=10.1186/1751-0473-3-17&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R20"> <span class="label">20.</span><cite>Sun GW, Shook TL, Kay GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol. 1996;49:907–16. doi: 10.1016/0895-4356(96)00025-x.</cite> [<a href="https://doi.org/10.1016/0895-4356(96)00025-x" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8699212/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=J%20Clin%20Epidemiol&title=Inappropriate%20use%20of%20bivariable%20analysis%20to%20screen%20risk%20factors%20for%20use%20in%20multivariable%20analysis&author=GW%20Sun&author=TL%20Shook&author=GL%20Kay&volume=49&publication_year=1996&pages=907-16&pmid=8699212&doi=10.1016/0895-4356(96)00025-x&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R21"> <span class="label">21.</span><cite>Lay CS, Tsai YT, Lee FY, et al. Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2006;21:413–9. doi: 10.1111/j.1440-1746.2005.04071.x.</cite> [<a href="https://doi.org/10.1111/j.1440-1746.2005.04071.x" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16509867/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=J%20Gastroenterol%20Hepatol&title=Endoscopic%20variceal%20ligation%20versus%20propranolol%20in%20prophylaxis%20of%20first%20variceal%20bleeding%20in%20patients%20with%20cirrhosis&author=CS%20Lay&author=YT%20Tsai&author=FY%20Lee&volume=21&publication_year=2006&pages=413-9&pmid=16509867&doi=10.1111/j.1440-1746.2005.04071.x&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R22"> <span class="label">22.</span><cite>Lo GH, Chen WC, Chen MH, et al. Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis. Gastrointest Endosc. 2004;59:333–8. doi: 10.1016/s0016-5107(03)02819-0.</cite> [<a href="https://doi.org/10.1016/s0016-5107(03)02819-0" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/14997127/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Gastrointest%20Endosc&title=Endoscopic%20ligation%20vs.%20nadolol%20in%20the%20prevention%20of%20first%20variceal%20bleeding%20in%20patients%20with%20cirrhosis&author=GH%20Lo&author=WC%20Chen&author=MH%20Chen&volume=59&publication_year=2004&pages=333-8&pmid=14997127&doi=10.1016/s0016-5107(03)02819-0&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R23"> <span class="label">23.</span><cite>Amitrano L, Brancaccio V, Guardascione MA, et al. Inherited coagulation disorders in cirrhotic patients with portal vein thrombosis. Hepatology. 2000;31:345–8. doi: 10.1002/hep.510310213.</cite> [<a href="https://doi.org/10.1002/hep.510310213" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10655256/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=Inherited%20coagulation%20disorders%20in%20cirrhotic%20patients%20with%20portal%20vein%20thrombosis&author=L%20Amitrano&author=V%20Brancaccio&author=MA%20Guardascione&volume=31&publication_year=2000&pages=345-8&pmid=10655256&doi=10.1002/hep.510310213&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R24"> <span class="label">24.</span><cite>Chen J, Duan ZP, Bai L, et al. Changing characteristic of blood coagulation factors and their correlation with blood coagulation status in different hepatic diseases. Zhonghua Gan Zang Bing Za Zhi. 2012;20:206–10. doi: 10.3760/cma.j.issn.1007-3418.2012.03.014.</cite> [<a href="https://doi.org/10.3760/cma.j.issn.1007-3418.2012.03.014" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22475141/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Zhonghua%20Gan%20Zang%20Bing%20Za%20Zhi&title=Changing%20characteristic%20of%20blood%20coagulation%20factors%20and%20their%20correlation%20with%20blood%20coagulation%20status%20in%20different%20hepatic%20diseases&author=J%20Chen&author=ZP%20Duan&author=L%20Bai&volume=20&publication_year=2012&pages=206-10&pmid=22475141&doi=10.3760/cma.j.issn.1007-3418.2012.03.014&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R25"> <span class="label">25.</span><cite>Violi F, Ferro D, Basili S, et al. Ongoing prothrombotic state in the portal circulation of cirrhotic patients. Thromb Haemost. 1997;77:44–7.</cite> [<a href="https://pubmed.ncbi.nlm.nih.gov/9031447/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Thromb%20Haemost&title=Ongoing%20prothrombotic%20state%20in%20the%20portal%20circulation%20of%20cirrhotic%20patients&author=F%20Violi&author=D%20Ferro&author=S%20Basili&volume=77&publication_year=1997&pages=44-7&pmid=9031447&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R26"> <span class="label">26.</span><cite>Wanless IR, Liu JJ, Butany J. Role of thrombosis in the pathogenesis of congestive hepatic fibrosis (cardiac cirrhosis) Hepatology. 1995;21:1232–7.</cite> [<a href="https://pubmed.ncbi.nlm.nih.gov/7737628/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=Role%20of%20thrombosis%20in%20the%20pathogenesis%20of%20congestive%20hepatic%20fibrosis%20(cardiac%20cirrhosis)&author=IR%20Wanless&author=JJ%20Liu&author=J%20Butany&volume=21&publication_year=1995&pages=1232-7&pmid=7737628&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R27"> <span class="label">27.</span><cite>Villa E, Camma C, Marietta M, et al. Enoxaparin prevents portal vein thrombosis and liver decompensation in patients with advanced cirrhosis. Gastroenterology. 2012;143:1253–60. e1–4. doi: 10.1053/j.gastro.2012.07.018.</cite> [<a href="https://doi.org/10.1053/j.gastro.2012.07.018" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22819864/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Gastroenterology&title=Enoxaparin%20prevents%20portal%20vein%20thrombosis%20and%20liver%20decompensation%20in%20patients%20with%20advanced%20cirrhosis&author=E%20Villa&author=C%20Camma&author=M%20Marietta&volume=143&publication_year=2012&pages=1253-60&pmid=22819864&doi=10.1053/j.gastro.2012.07.018&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R28"> <span class="label">28.</span><cite>Francoz C, Belghiti J, Vilgrain V, et al. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation. Gut. 2005;54:691–7. doi: 10.1136/gut.2004.042796.</cite> [<a href="https://doi.org/10.1136/gut.2004.042796" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC1774501/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15831918/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Gut&title=Splanchnic%20vein%20thrombosis%20in%20candidates%20for%20liver%20transplantation:%20usefulness%20of%20screening%20and%20anticoagulation&author=C%20Francoz&author=J%20Belghiti&author=V%20Vilgrain&volume=54&publication_year=2005&pages=691-7&pmid=15831918&doi=10.1136/gut.2004.042796&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R29"> <span class="label">29.</span><cite>Northup PG, McMahon MM, Ruhl AP, et al. Coagulopathy does not fully protect hospitalized cirrhosis patients from peripheral venous thromboembolism. The American Journal of Gastroenterology. 2006;101:1524–8. doi: 10.1111/j.1572-0241.2006.00588.x. quiz 1680.</cite> [<a href="https://doi.org/10.1111/j.1572-0241.2006.00588.x" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16863556/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=The%20American%20Journal%20of%20Gastroenterology&title=Coagulopathy%20does%20not%20fully%20protect%20hospitalized%20cirrhosis%20patients%20from%20peripheral%20venous%20thromboembolism&author=PG%20Northup&author=MM%20McMahon&author=AP%20Ruhl&volume=101&publication_year=2006&pages=1524-8&pmid=16863556&doi=10.1111/j.1572-0241.2006.00588.x&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R30"> <span class="label">30.</span><cite>Zoli M, Marchesini G, Brunori A, et al. Portal venous flow in response to acute beta-blocker and vasodilatatory treatment in patients with liver cirrhosis. Hepatology. 1986;6:1248–51. doi: 10.1002/hep.1840060604.</cite> [<a href="https://doi.org/10.1002/hep.1840060604" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/2878867/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Hepatology&title=Portal%20venous%20flow%20in%20response%20to%20acute%20beta-blocker%20and%20vasodilatatory%20treatment%20in%20patients%20with%20liver%20cirrhosis&author=M%20Zoli&author=G%20Marchesini&author=A%20Brunori&volume=6&publication_year=1986&pages=1248-51&pmid=2878867&doi=10.1002/hep.1840060604&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R31"> <span class="label">31.</span><cite>Westaby D, Bihari DJ, Gimson AE, et al. Selective and non-selective beta receptor blockade in the reduction of portal pressure in patients with cirrhosis and portal hypertension. Gut. 1984;25:121–4. doi: 10.1136/gut.25.2.121.</cite> [<a href="https://doi.org/10.1136/gut.25.2.121" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC1432254/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/6693039/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Gut&title=Selective%20and%20non-selective%20beta%20receptor%20blockade%20in%20the%20reduction%20of%20portal%20pressure%20in%20patients%20with%20cirrhosis%20and%20portal%20hypertension&author=D%20Westaby&author=DJ%20Bihari&author=AE%20Gimson&volume=25&publication_year=1984&pages=121-4&pmid=6693039&doi=10.1136/gut.25.2.121&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R32"> <span class="label">32.</span><cite>Stine JG, Shah NL, Argo CK, et al. Increased risk of portal vein thrombosis in patients with cirrhosis due to nonalcoholic steatohepatitis. Liver Transpl. 2015;21:1016–21. doi: 10.1002/lt.24134.</cite> [<a href="https://doi.org/10.1002/lt.24134" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC6615024/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25845711/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=Liver%20Transpl&title=Increased%20risk%20of%20portal%20vein%20thrombosis%20in%20patients%20with%20cirrhosis%20due%20to%20nonalcoholic%20steatohepatitis&author=JG%20Stine&author=NL%20Shah&author=CK%20Argo&volume=21&publication_year=2015&pages=1016-21&pmid=25845711&doi=10.1002/lt.24134&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R33"> <span class="label">33.</span><cite>Stine JG, Argo CK, Pelletier SJ, et al. Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant portal vein thrombosis. World J Hepatol. 2017;9:139–146. doi: 10.4254/wjh.v9.i3.139.</cite> [<a href="https://doi.org/10.4254/wjh.v9.i3.139" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="/articles/PMC5295147/" class="usa-link">PMC free article</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28217250/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=World%20J%20Hepatol&title=Advanced%20non-alcoholic%20steatohepatitis%20cirrhosis:%20A%20high-risk%20population%20for%20pre-liver%20transplant%20portal%20vein%20thrombosis&author=JG%20Stine&author=CK%20Argo&author=SJ%20Pelletier&volume=9&publication_year=2017&pages=139-146&pmid=28217250&doi=10.4254/wjh.v9.i3.139&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> <li id="R34"> <span class="label">34.</span><cite>Qi X, De Stefano V, Wang J, et al. Prevalence of inherited antithrombin, protein C, and protein S deficiencies in portal vein system thrombosis and Budd-Chiari syndrome: a systematic review and meta-analysis of observational studies. J Gastroenterol Hepatol. 2013;28:432–42. doi: 10.1111/jgh.12085.</cite> [<a href="https://doi.org/10.1111/jgh.12085" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">DOI</a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23216127/" class="usa-link">PubMed</a>] [<a href="https://scholar.google.com/scholar_lookup?journal=J%20Gastroenterol%20Hepatol&title=Prevalence%20of%20inherited%20antithrombin,%20protein%20C,%20and%20protein%20S%20deficiencies%20in%20portal%20vein%20system%20thrombosis%20and%20Budd-Chiari%20syndrome:%20a%20systematic%20review%20and%20meta-analysis%20of%20observational%20studies&author=X%20Qi&author=V%20De%20Stefano&author=J%20Wang&volume=28&publication_year=2013&pages=432-42&pmid=23216127&doi=10.1111/jgh.12085&" class="usa-link usa-link--external" data-ga-action="click_feat_suppl" target="_blank" rel="noopener noreferrer">Google Scholar</a>]</li> </ul></section></section></section></section></article> </main> </div> </div> </div>  <div class="pmc-sidenav desktop:grid-col-4 display-flex"> <section class="pmc-sidenav__container" aria-label="Article resources and navigation"> <button type="button" class="usa-button pmc-sidenav__container__close usa-button--unstyled"> <img src="/static/img/usa-icons/close.svg" role="img" alt="Close" /> </button> <div class="display-none desktop:display-block"> <section class="margin-top-4 desktop:margin-top-0"> <h2 class="margin-top-0">ACTIONS</h2> <ul class="usa-list usa-list--unstyled usa-list--actions"> <li> <a href="https://doi.org/10.1111/liv.13500" class="usa-button usa-button--outline width-24 font-xs usa-link--external padding-left-0 padding-right-0" target="_blank" rel="noreferrer noopener" data-ga-category="actions" data-ga-action="click" data-ga-label="publisher_link_desktop" > <span class="height-3 display-inline-flex flex-align-center">View on publisher site</span> </a> </li> <li> <a href="pdf/nihms886108.pdf" class="usa-button usa-button--outline width-24 display-inline-flex flex-align-center flex-justify-start padding-left-1" data-ga-category="actions" data-ga-action="click" data-ga-label="pdf_download_desktop" > <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/sprite.svg#file_download"></use> </svg> <span class="display-inline-flex flex-justify-center flex-1">PDF (462.6 KB)</span> </a> </li> <li> <button role="button" class="usa-button width-24 citation-dialog-trigger display-inline-flex flex-align-center flex-justify-start padding-left-1" aria-label="Open dialog with citation text in different styles" data-ga-category="actions" data-ga-action="open" data-ga-label="cite_desktop" data-all-citations-url="/resources/citations/10540634/" data-citation-style="nlm" data-download-format-link="/resources/citations/10540634/export/" > <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/sprite.svg#format_quote"></use> </svg> <span class="display-inline-flex flex-justify-center flex-1 button-label">Cite</span> </button> </li> <li> <button class="usa-button width-24 collections-dialog-trigger collections-button display-inline-flex flex-align-center flex-justify-start padding-left-1 collections-button-empty" aria-label="Save article in MyNCBI collections." data-ga-category="actions" data-ga-action="click" data-ga-label="collections_button_desktop" data-collections-open-dialog-enabled="false" data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpmc.ncbi.nlm.nih.gov%2Farticles%2FPMC10540634%2F%23open-collections-dialog" data-in-collections="false"> <svg class="usa-icon width-3 height-3 usa-icon--bookmark-full" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/action-bookmark-full.svg#icon"></use> </svg> <svg class="usa-icon width-3 height-3 usa-icon--bookmark-empty" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/action-bookmark-empty.svg#icon"></use> </svg> <span class="display-inline-flex flex-justify-center flex-1">Collections</span> </button> </li> <li class="pmc-permalink"> <button type="button" class="usa-button usa-button--outline width-24 display-inline-flex flex-align-center flex-justify padding-left-1 shadow-none" aria-label="Show article permalink" aria-expanded="false" aria-haspopup="true" data-ga-category="actions" data-ga-action="open" data-ga-label="permalink_desktop" > <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img" hidden> <use xlink:href="/static/img/sprite.svg#share"></use> </svg> <span class="display-inline-flex flex-justify-center flex-1 button-label">Permalink</span> </button> <div class="pmc-permalink__dropdown" hidden> <div class="pmc-permalink__dropdown__container"> <h2 class="usa-modal__heading margin-top-0 margin-bottom-2">PERMALINK</h2> <div class="pmc-permalink__dropdown__content"> <input type="text" class="usa-input" value="https://pmc.ncbi.nlm.nih.gov/articles/PMC10540634/" aria-label="Article permalink"> <button class="usa-button display-inline-flex pmc-permalink__dropdown__copy__btn margin-right-0" title="Copy article permalink" data-ga-category="save_share" data-ga-action="link" data-ga-label="copy_link"> <svg class="usa-icon" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#content_copy"></use> </svg> <span class="margin-left-1">Copy</span> </button> </div> </div> </div> </li> </ul> </section> </div> <section class="pmc-resources margin-top-6 desktop:margin-top-4" data-page-path="/articles/PMC10540634/"> <h2 class="margin-top-0">RESOURCES</h2> <div class="usa-accordion usa-accordion--multiselectable" data-allow-multiple> <h3 class="usa-accordion__heading"> <button type="button" class="usa-accordion__button" aria-expanded="false" aria-controls="resources-similar-articles" data-ga-category="resources_accordion" data-ga-action="open_similar_articles" data-ga-label="/articles/PMC10540634/" data-action-open="open_similar_articles" data-action-close="close_similar_articles" > Similar articles </button> </h3> <div id="resources-similar-articles" class="usa-accordion__content usa-prose" data-source-url="/resources/similar-article-links/28632958/" > </div> <h3 class="usa-accordion__heading"> <button type="button" class="usa-accordion__button" aria-expanded="false" aria-controls="resources-cited-by-other-articles" data-ga-category="resources_accordion" data-ga-action="open_cited_by" data-ga-label="/articles/PMC10540634/" data-action-open="open_cited_by" data-action-close="close_cited_by" > Cited by other articles </button> </h3> <div id="resources-cited-by-other-articles" class="usa-accordion__content usa-prose" data-source-url="/resources/cited-by-links/28632958/" > </div> <h3 class="usa-accordion__heading"> <button type="button" class="usa-accordion__button" aria-expanded="false" aria-controls="resources-links-to-ncbi-databases" data-ga-category="resources_accordion" data-ga-action="open_NCBI_links" data-ga-label="/articles/PMC10540634/" data-action-open="open_NCBI_links" data-action-close="close_NCBI_link" > Links to NCBI Databases </button> </h3> <div id="resources-links-to-ncbi-databases" class="usa-accordion__content usa-prose" data-source-url="/resources/db-links/10540634/" > </div> </div> </section> <section class="usa-in-page-nav usa-in-page-nav--wide margin-top-6 desktop:margin-top-4" data-title-text="On this page" data-title-heading-level="h2" data-scroll-offset="0" data-root-margin="-10% 0px -80% 0px" data-main-content-selector="main" data-threshold="1" hidden ></section> </section> </div> <div class="overlay" role="dialog" aria-label="Citation Dialog" hidden> <div class="dialog citation-dialog" aria-hidden="true"> <div class="display-inline-flex flex-align-center flex-justify width-full margin-bottom-2"> <h2 class="usa-modal__heading margin-0">Cite</h2> <button type="button" class="usa-button usa-button--unstyled close-overlay text-black width-auto" tabindex="1"> <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#close"></use> </svg> </button> </div> <div class="citation-text-block"> <div class="citation-text margin-bottom-2"></div> <ul class="usa-list usa-list--unstyled display-inline-flex flex-justify width-full flex-align-center"> <li> <button class="usa-button usa-button--unstyled text-no-underline display-flex flex-align-center copy-button dialog-focus" data-ga-category="save_share" data-ga-action="cite" data-ga-label="copy" tabindex="2"> <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#content_copy"></use> </svg> <span>Copy</span> </button> </li> <li> <a href="#" role="button" class="usa-button usa-button--unstyled text-no-underline display-flex flex-align-center export-button" data-ga-category="save_share" data-ga-action="cite" data-ga-label="download" title="Download a file for external citation management software" tabindex="3"> <svg class="usa-icon width-3 height-3" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#file_download"></use> </svg> <span class="display-none mobile-lg:display-inline">Download .nbib</span> <span class="display-inline mobile-lg:display-none">.nbib</span> </a> </li> <li> <div class="display-inline-flex flex-align-center"> <label class="usa-label margin-top-0">Format:</label> <select aria-label="Format" class="usa-select citation-style-selector padding-1 margin-top-0 border-0 padding-right-4" tabindex="4" > <option data-style-url-name="ama" value="AMA" > AMA </option> <option data-style-url-name="apa" value="APA" > APA </option> <option data-style-url-name="mla" value="MLA" > MLA </option> <option data-style-url-name="nlm" value="NLM" selected="selected"> NLM </option> </select> </div> </li> </ul> </div> </div> </div> <div class="overlay" role="dialog" hidden> <div id="collections-action-dialog" class="dialog collections-dialog" aria-hidden="true"> <div class="display-inline-flex flex-align-center flex-justify width-full margin-bottom-2"> <h2 class="usa-modal__heading margin-0">Add to Collections</h2> </div> <div class="collections-action-panel action-panel"> <form id="collections-action-dialog-form" class="usa-form maxw-full collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors" data-existing-collections-url="/list-existing-collections/" data-add-to-existing-collection-url="/add-to-existing-collection/" data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/" data-myncbi-max-collection-name-length="100" data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/"> <input type="hidden" name="csrfmiddlewaretoken" value="8bw7XrrFUYtpNAY8PEduh7GSOW6fc7k8c0tJva309zWKsB9M23vwfXobUmSRSR2N"> <fieldset class="usa-fieldset margin-bottom-2"> <div class="usa-radio"> <input type="radio" id="collections-action-dialog-new" class="usa-radio__input usa-radio__input--tile collections-new margin-top-0" name="collections" value="new" data-ga-category="collections_button" data-ga-action="click" data-ga-label="collections_radio_new" /> <label class="usa-radio__label" for="collections-action-dialog-new">Create a new collection</label> </div> <div class="usa-radio"> <input type="radio" id="collections-action-dialog-existing" class="usa-radio__input usa-radio__input--tile collections-existing" name="collections" value="existing" checked="true" data-ga-category="collections_button" data-ga-action="click" data-ga-label="collections_radio_existing" /> <label class="usa-radio__label" for="collections-action-dialog-existing">Add to an existing collection</label> </div> </fieldset> <fieldset class="usa-fieldset margin-bottom-2"> <div class="action-panel-control-wrap new-collections-controls"> <label for="collections-action-dialog-add-to-new" class="usa-label margin-top-0"> Name your collection <abbr title="required" class="usa-hint usa-hint--required text-no-underline">*</abbr> </label> <input type="text" name="add-to-new-collection" id="collections-action-dialog-add-to-new" class="usa-input collections-action-add-to-new" pattern="[^"&=<>/]*" title="The following characters are not allowed in the Name field: "&=<>/" maxlength="" data-ga-category="collections_button" data-ga-action="create_collection" data-ga-label="non_favorties_collection" required /> </div> <div class="action-panel-control-wrap existing-collections-controls"> <label for="collections-action-dialog-add-to-existing" class="usa-label margin-top-0"> Choose a collection </label> <select id="collections-action-dialog-add-to-existing" class="usa-select collections-action-add-to-existing" data-ga-category="collections_button" data-ga-action="select_collection" data-ga-label="($('.collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'"> </select> <div class="collections-retry-load-on-error usa-input-error-message selection-validation-message"> Unable to load your collection due to an error<br> <a href="#">Please try again</a> </div> </div> </fieldset> <div class="display-inline-flex"> <button class="usa-button margin-top-0 action-panel-submit" type="submit" data-loading-label="Adding..." data-pinger-ignore data-ga-category="collections_button" data-ga-action="click" data-ga-label="add"> Add </button> <button class="usa-button usa-button--outline margin-top-0 action-panel-cancel" aria-label="Close 'Add to Collections' panel" ref="linksrc=close_collections_panel" data-ga-category="collections_button" data-ga-action="click" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> </div> </div> </div> </div> <footer class="ncbi-footer ncbi-dark-background " > <div class="ncbi-footer__icon-section"> <div class="ncbi-footer__social-header"> Follow NCBI </div> <div class="grid-container ncbi-footer__ncbi-social-icons-container"> <a href="https://twitter.com/ncbi" class="ncbi-footer__social-icon ncbi-footer__social-icon--gray" target="_blank" rel="noreferrer noopener"> <svg width="40" height="40" viewBox="0 0 40 40" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="m6.067 8 10.81 13.9L6 33.2h4.2l8.4-9.1 7.068 9.1H34L22.8 18.5 31.9 8h-3.5l-7.7 8.4L14.401 8H6.067Zm3.6 1.734h3.266l16.8 21.732H26.57L9.668 9.734Z"> </path> </svg> <span class="usa-sr-only">NCBI on X (formerly known as Twitter)</span> </a> <a href="https://www.facebook.com/ncbi.nlm" class="ncbi-footer__social-icon ncbi-footer__social-icon--gray" target="_blank" rel="noreferrer noopener"> <svg width="16" height="29" focusable="false" aria-hidden="true" viewBox="0 0 16 29" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M3.8809 21.4002C3.8809 19.0932 3.8809 16.7876 3.8809 14.478C3.8809 14.2117 3.80103 14.1452 3.54278 14.1492C2.53372 14.1638 1.52334 14.1492 0.514288 14.1598C0.302626 14.1598 0.248047 14.0972 0.248047 13.8936C0.256034 12.4585 0.256034 11.0239 0.248047 9.58978C0.248047 9.37013 0.302626 9.30224 0.528931 9.3049C1.53798 9.31688 2.54837 9.3049 3.55742 9.31555C3.80103 9.31555 3.8809 9.26097 3.87957 9.00272C3.87158 8.00565 3.85428 7.00592 3.90753 6.00884C3.97142 4.83339 4.31487 3.73115 5.04437 2.78467C5.93095 1.63318 7.15699 1.09005 8.56141 0.967577C10.5582 0.79319 12.555 0.982221 14.5518 0.927641C14.7102 0.927641 14.7462 0.99287 14.7449 1.13664C14.7449 2.581 14.7449 4.02668 14.7449 5.47104C14.7449 5.67604 14.6517 5.68669 14.4946 5.68669C13.4523 5.68669 12.4113 5.68669 11.3703 5.68669C10.3506 5.68669 9.92057 6.10868 9.90593 7.13904C9.89661 7.7647 9.91525 8.39303 9.89794 9.01869C9.88995 9.26364 9.96583 9.31822 10.2015 9.31688C11.7204 9.30623 13.2393 9.31688 14.7595 9.3049C15.0257 9.3049 15.0723 9.3728 15.0444 9.62439C14.89 10.9849 14.7515 12.3467 14.6144 13.7085C14.5691 14.1571 14.5785 14.1585 14.1458 14.1585C12.8386 14.1585 11.5313 14.1665 10.2254 14.1518C9.95119 14.1518 9.89794 14.2317 9.89794 14.4899C9.90593 19.0799 9.89794 23.6752 9.91125 28.2612C9.91125 28.5674 9.8407 28.646 9.53186 28.6433C7.77866 28.6273 6.02414 28.6366 4.27094 28.634C3.82499 28.634 3.87158 28.6992 3.87158 28.22C3.87602 25.9472 3.87913 23.6739 3.8809 21.4002Z"> </path> </svg> <span class="usa-sr-only">NCBI on Facebook</span> </a> <a href="https://www.linkedin.com/company/ncbinlm" class="ncbi-footer__social-icon ncbi-footer__social-icon--gray" target="_blank" rel="noreferrer noopener"> <svg width="25" height="23" viewBox="0 0 26 24" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="M14.6983 9.98423C15.6302 9.24808 16.5926 8.74754 17.6762 8.51991C19.673 8.09126 21.554 8.30824 23.1262 9.7526C24.2351 10.7723 24.7529 12.1115 25.0165 13.5612C25.1486 14.3363 25.2105 15.1218 25.2015 15.9081C25.2015 18.3043 25.2015 20.6898 25.2082 23.0806C25.2082 23.3468 25.1549 23.444 24.8621 23.4414C23.1297 23.4272 21.3992 23.4272 19.6704 23.4414C19.4041 23.4414 19.3429 23.3588 19.3442 23.1019C19.3535 20.5194 19.3442 17.9368 19.3442 15.3543C19.3442 14.0005 18.3258 12.9448 17.0266 12.9488C15.7273 12.9528 14.6983 14.0071 14.6983 15.361C14.6983 17.9328 14.6917 20.5047 14.6983 23.0753C14.6983 23.3708 14.6198 23.444 14.3296 23.4427C12.6185 23.4294 10.9079 23.4294 9.19779 23.4427C8.93155 23.4427 8.86099 23.3735 8.86232 23.1086C8.8783 19.7619 8.88628 16.4144 8.88628 13.066C8.88628 11.5688 8.87874 10.0708 8.86365 8.57182C8.86365 8.3575 8.90758 8.27896 9.14054 8.28029C10.9048 8.29094 12.6687 8.29094 14.4321 8.28029C14.6464 8.28029 14.6983 8.34818 14.6983 8.54653C14.6903 9.00047 14.6983 9.45441 14.6983 9.98423Z"> </path> <path d="M6.55316 15.8443C6.55316 18.2564 6.55316 20.6699 6.55316 23.082C6.55316 23.3629 6.48127 23.4388 6.19906 23.4374C4.47737 23.4241 2.75568 23.4241 1.03399 23.4374C0.767751 23.4374 0.69986 23.3629 0.701191 23.1006C0.709178 18.2648 0.709178 13.4281 0.701191 8.59053C0.701191 8.34026 0.765089 8.27237 1.01669 8.2737C2.74991 8.28435 4.48048 8.28435 6.20838 8.2737C6.47462 8.2737 6.5465 8.33627 6.54517 8.6065C6.54783 11.0186 6.55316 13.4308 6.55316 15.8443Z"> </path> <path d="M3.65878 0.243898C5.36804 0.243898 6.58743 1.45529 6.58743 3.1406C6.58743 4.75801 5.32145 5.95742 3.60819 5.96807C3.22177 5.97614 2.83768 5.90639 2.47877 5.76299C2.11985 5.61959 1.79344 5.40546 1.51897 5.13334C1.24449 4.86123 1.02755 4.53668 0.881058 4.17902C0.734563 3.82136 0.661505 3.43788 0.666231 3.05141C0.67555 1.42601 1.9362 0.242566 3.65878 0.243898Z"> </path> </svg> <span class="usa-sr-only">NCBI on LinkedIn</span> </a> <a href="https://github.com/ncbi" class="ncbi-footer__social-icon ncbi-footer__social-icon--gray" target="_blank" rel="noreferrer noopener"> <svg width="28" height="27" viewBox="0 0 28 28" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="M16.7228 20.6334C17.5057 20.5527 18.2786 20.3944 19.0301 20.1608C21.3108 19.4193 22.5822 17.8259 22.963 15.4909C23.1228 14.5112 23.1814 13.5287 22.9883 12.5437C22.8106 11.6423 22.4013 10.8028 21.8007 10.1076C21.7526 10.0605 21.7197 10 21.7064 9.934C21.6931 9.86799 21.7 9.79952 21.7262 9.73748C22.0856 8.6206 21.9711 7.51969 21.601 6.42677C21.582 6.3497 21.5345 6.2827 21.468 6.23923C21.4016 6.19577 21.3211 6.17906 21.2429 6.19248C20.7329 6.21649 20.2313 6.33051 19.7611 6.52928C19.1103 6.7908 18.4899 7.12198 17.9104 7.51703C17.84 7.56996 17.7581 7.60551 17.6713 7.62078C17.5846 7.63605 17.4954 7.6306 17.4112 7.60489C15.2596 7.05882 13.0054 7.06203 10.8554 7.61421C10.7806 7.63586 10.7018 7.63967 10.6253 7.62534C10.5487 7.611 10.4766 7.57892 10.4148 7.53167C9.64788 7.03247 8.85171 6.58918 7.96368 6.33359C7.65781 6.24338 7.34123 6.19458 7.02239 6.18849C6.94879 6.17986 6.87462 6.19893 6.81432 6.242C6.75402 6.28507 6.71191 6.34904 6.69621 6.42145C6.32342 7.51437 6.2209 8.61527 6.56307 9.73348C6.59635 9.84264 6.64694 9.93316 6.54177 10.0516C5.47666 11.2604 5.09988 12.6834 5.19574 14.2676C5.2663 15.4244 5.46201 16.5466 6.01454 17.5769C6.84399 19.1171 8.21664 19.9119 9.85158 20.3352C10.3938 20.4706 10.9444 20.5698 11.4998 20.632C11.5384 20.7492 11.4506 20.7798 11.408 20.8291C11.1734 21.1179 10.9894 21.4441 10.8634 21.7942C10.7622 22.0458 10.8315 22.4039 10.6065 22.5516C10.263 22.7766 9.83827 22.8485 9.42421 22.8871C8.17936 23.0056 7.26471 22.4877 6.6283 21.4348C6.25552 20.8184 5.76956 20.3325 5.08523 20.0663C4.76981 19.9325 4.42139 19.8967 4.08537 19.9638C3.7898 20.029 3.73788 20.1901 3.93891 20.4111C4.03639 20.5234 4.14989 20.6207 4.27575 20.6999C4.9796 21.1318 5.51717 21.7884 5.80152 22.5636C6.37002 23.9973 7.48039 24.5697 8.93825 24.6323C9.43741 24.6575 9.93768 24.615 10.4254 24.5058C10.5892 24.4672 10.6531 24.4872 10.6517 24.6762C10.6451 25.4936 10.6637 26.3123 10.6517 27.131C10.6517 27.6635 10.1684 27.9297 9.58663 27.7393C8.17396 27.2671 6.84977 26.5631 5.66838 25.656C2.59555 23.2891 0.720966 20.1861 0.217704 16.3376C-0.357453 11.9127 0.911353 8.00824 3.98551 4.73881C6.11909 2.42656 8.99932 0.939975 12.1203 0.540191C16.5351 -0.0601815 20.4347 1.14323 23.7232 4.16373C26.2449 6.47869 27.724 9.37672 28.1048 12.7726C28.5828 17.0325 27.3686 20.7945 24.4768 23.9827C22.9762 25.6323 21.0956 26.8908 18.9982 27.6488C18.8783 27.6927 18.7585 27.738 18.636 27.7726C18.0356 27.9404 17.6189 27.6395 17.6189 27.0098C17.6189 25.7452 17.6308 24.4806 17.6295 23.2159C17.6329 22.9506 17.6128 22.6856 17.5696 22.4238C17.4325 21.6664 17.3419 21.484 16.7228 20.6334Z"> </path> </svg> <span class="usa-sr-only">NCBI on GitHub</span> </a> <a href="https://ncbiinsights.ncbi.nlm.nih.gov/" class="ncbi-footer__social-icon ncbi-footer__social-icon--gray" target="_blank" rel="noreferrer noopener"> <svg width="26" height="26" viewBox="0 0 27 27" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="M23.7778 26.4574C23.1354 26.3913 22.0856 26.8024 21.636 26.3087C21.212 25.8444 21.4359 24.8111 21.324 24.0347C19.9933 14.8323 14.8727 8.80132 6.09057 5.85008C4.37689 5.28406 2.58381 4.99533 0.779072 4.99481C0.202773 4.99481 -0.0229751 4.83146 0.00455514 4.21479C0.0660406 3.08627 0.0660406 1.95525 0.00455514 0.826734C-0.0413285 0.0815827 0.259669 -0.0193618 0.896534 0.00266238C6.96236 0.222904 12.3693 2.24179 16.9889 6.16209C22.9794 11.2478 26.1271 17.7688 26.4372 25.648C26.4629 26.294 26.3179 26.5271 25.6609 26.4684C25.0827 26.417 24.4991 26.4574 23.7778 26.4574Z"> </path> <path d="M14.8265 26.441C14.0924 26.441 13.2371 26.6795 12.6626 26.3786C12.0092 26.0372 12.3781 25.0644 12.246 24.378C11.1154 18.5324 6.6849 14.5497 0.74755 14.1001C0.217135 14.0615 -0.0104482 13.9422 0.0134113 13.3659C0.0519536 12.1454 0.0482829 10.9213 0.0134113 9.69524C-0.00127145 9.14464 0.196946 9.03268 0.703502 9.04736C9.21217 9.27128 16.5994 16.2511 17.2804 24.7231C17.418 26.4446 17.418 26.4446 15.6579 26.4446H14.832L14.8265 26.441Z"> </path> <path d="M3.58928 26.4555C2.64447 26.4618 1.73584 26.0925 1.06329 25.4289C0.39073 24.7653 0.00933763 23.8617 0.0030097 22.9169C-0.00331824 21.9721 0.365937 21.0635 1.02954 20.3909C1.69315 19.7184 2.59675 19.337 3.54156 19.3306C4.48637 19.3243 5.39499 19.6936 6.06755 20.3572C6.7401 21.0208 7.1215 21.9244 7.12782 22.8692C7.13415 23.814 6.7649 24.7226 6.10129 25.3952C5.43768 26.0677 4.53409 26.4491 3.58928 26.4555Z"> </path> </svg> <span class="usa-sr-only">NCBI RSS feed</span> </a> </div> </div> <div data-testid="gridContainer" class="grid-container ncbi-footer__container"> <div class="grid-row ncbi-footer__main-content-container" data-testid="grid"> <div class="ncbi-footer__column"> <p class="ncbi-footer__circled-icons-heading"> Connect with NLM </p> <div class="ncbi-footer__circled-icons-list"> <a href=https://twitter.com/nlm_nih class="ncbi-footer__social-icon ncbi-footer__social-icon--circled" target="_blank" rel="noreferrer noopener"> <svg width="32" height="32" viewBox="0 0 40 40" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="m6.067 8 10.81 13.9L6 33.2h4.2l8.4-9.1 7.068 9.1H34L22.8 18.5 31.9 8h-3.5l-7.7 8.4L14.401 8H6.067Zm3.6 1.734h3.266l16.8 21.732H26.57L9.668 9.734Z"> </path> </svg> <span class="usa-sr-only">NLM on X (formerly known as Twitter)</span> </a> <a href=https://www.facebook.com/nationallibraryofmedicine class="ncbi-footer__social-icon ncbi-footer__social-icon--circled" target="_blank" rel="noreferrer noopener"> <svg width="13" height="24" viewBox="0 0 13 24" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="M4.11371 23.1369C4.11371 23.082 4.11371 23.0294 4.11371 22.9745V12.9411H0.817305C0.6709 12.9411 0.670898 12.9411 0.670898 12.8016C0.670898 11.564 0.670898 10.3287 0.670898 9.09341C0.670898 8.97903 0.705213 8.95158 0.815017 8.95158C1.8673 8.95158 2.91959 8.95158 3.97417 8.95158H4.12057V8.83263C4.12057 7.8055 4.12057 6.7738 4.12057 5.74897C4.1264 4.92595 4.31387 4.11437 4.66959 3.37217C5.12916 2.38246 5.94651 1.60353 6.95717 1.1921C7.64827 0.905008 8.3913 0.764035 9.13953 0.778051C10.0019 0.791777 10.8644 0.830666 11.7268 0.860404C11.8869 0.860404 12.047 0.894717 12.2072 0.90158C12.2964 0.90158 12.3261 0.940469 12.3261 1.02968C12.3261 1.5421 12.3261 2.05452 12.3261 2.56465C12.3261 3.16857 12.3261 3.7725 12.3261 4.37642C12.3261 4.48165 12.2964 4.51367 12.1912 4.51138C11.5369 4.51138 10.8804 4.51138 10.2261 4.51138C9.92772 4.51814 9.63058 4.5526 9.33855 4.61433C9.08125 4.6617 8.84537 4.78881 8.66431 4.97766C8.48326 5.16652 8.3662 5.40755 8.32972 5.66661C8.28476 5.89271 8.26027 6.1224 8.25652 6.35289C8.25652 7.19014 8.25652 8.02969 8.25652 8.86923C8.25652 8.89439 8.25652 8.91955 8.25652 8.95615H12.0219C12.1797 8.95615 12.182 8.95616 12.1614 9.10714C12.0768 9.76596 11.9876 10.4248 11.9029 11.0813C11.8312 11.6319 11.7626 12.1824 11.697 12.733C11.6719 12.9434 11.6787 12.9434 11.4683 12.9434H8.26338V22.899C8.26338 22.979 8.26338 23.0591 8.26338 23.1392L4.11371 23.1369Z"> </path> </svg> <span class="usa-sr-only">NLM on Facebook</span> </a> <a href=https://www.youtube.com/user/NLMNIH class="ncbi-footer__social-icon ncbi-footer__social-icon--circled" target="_blank" rel="noreferrer noopener"> <svg width="21" height="15" viewBox="0 0 21 15" fill="none" xmlns="http://www.w3.org/2000/svg" focusable="false" aria-hidden="true"> <path d="M19.2561 1.47914C18.9016 1.15888 18.5699 0.957569 17.2271 0.834039C15.5503 0.678484 13.2787 0.655608 11.563 0.65332H9.43556C7.71987 0.65332 5.4483 0.678484 3.77151 0.834039C2.43098 0.957569 2.097 1.15888 1.74242 1.47914C0.813665 2.32097 0.619221 4.62685 0.598633 6.89384C0.598633 7.31781 0.598633 7.74101 0.598633 8.16345C0.626084 10.4121 0.827391 12.686 1.74242 13.521C2.097 13.8412 2.4287 14.0425 3.77151 14.1661C5.4483 14.3216 7.71987 14.3445 9.43556 14.3468H11.563C13.2787 14.3468 15.5503 14.3216 17.2271 14.1661C18.5676 14.0425 18.9016 13.8412 19.2561 13.521C20.1712 12.6929 20.3725 10.451 20.3999 8.22064C20.3999 7.74025 20.3999 7.25986 20.3999 6.77946C20.3725 4.54907 20.1689 2.30724 19.2561 1.47914ZM8.55942 10.5311V4.65201L13.5601 7.50005L8.55942 10.5311Z" fill="white" /> </svg> <span class="usa-sr-only">NLM on YouTube</span> </a> </div> </div> <address class="ncbi-footer__address ncbi-footer__column"> <p> <a class="usa-link usa-link--external" href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/%4038.9959508, -77.101021,17z/data%3D!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb%3A0x19156f88b27635b8!8m2!3d38.9959508! 4d-77.0988323" rel="noopener noreferrer" target="_blank">National Library of Medicine <br/> 8600 Rockville Pike<br/> Bethesda, MD 20894</a> </p> </address> <ul class="usa-list usa-list--unstyled ncbi-footer__vertical-list ncbi-footer__column"> <li class="ncbi-footer__vertical-list-item"> <a href="https://www.nlm.nih.gov/web_policies.html" class="usa-link usa-link--alt ncbi-footer__link" > Web Policies </a> </li> <li class="ncbi-footer__vertical-list-item"> <a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="usa-link usa-link--alt ncbi-footer__link" > FOIA </a> </li> <li class="ncbi-footer__vertical-list-item"> <a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="usa-link usa-link--external usa-link--alt ncbi-footer__link" rel="noreferrer noopener" target='_blank' > HHS Vulnerability Disclosure </a> </li> </ul> <ul class="usa-list usa-list--unstyled ncbi-footer__vertical-list ncbi-footer__column"> <li class="ncbi-footer__vertical-list-item"> <a href="https://support.nlm.nih.gov/" class="usa-link usa-link--alt ncbi-footer__link" > Help </a> </li> <li class="ncbi-footer__vertical-list-item"> <a href="https://www.nlm.nih.gov/accessibility.html" class="usa-link usa-link--alt ncbi-footer__link" > Accessibility </a> </li> <li class="ncbi-footer__vertical-list-item"> <a href="https://www.nlm.nih.gov/careers/careers.html" class="usa-link usa-link--alt ncbi-footer__link" > Careers </a> </li> </ul> </div> <div class="grid-row grid-col-12" data-testid="grid"> <ul class="ncbi-footer__bottom-links-list"> <li class="ncbi-footer__bottom-list-item"> <a href="https://www.nlm.nih.gov/" class="usa-link usa-link--alt ncbi-footer__link" > NLM </a> </li> <li class="ncbi-footer__bottom-list-item"> <a href="https://www.nih.gov/" class="usa-link usa-link--alt ncbi-footer__link" > NIH </a> </li> <li class="ncbi-footer__bottom-list-item"> <a href="https://www.hhs.gov/" class="usa-link usa-link--external usa-link--alt ncbi-footer__link" rel="noreferrer noopener" target='_blank' > HHS </a> </li> <li class="ncbi-footer__bottom-list-item"> <a href="https://www.usa.gov/" class="usa-link usa-link--external usa-link--alt ncbi-footer__link" rel="noreferrer noopener" target='_blank' > USA.gov </a> </li> </ul> </div> </div> </footer> <script type="text/javascript" src="https://cdn.ncbi.nlm.nih.gov/core/pinger/pinger.js"> </script> <button class="back-to-top" data-ga-category="pagination" data-ga-action="back_to_top"> <label>Back to Top</label> <svg class="usa-icon order-0" aria-hidden="true" focusable="false" role="img"> <use xlink:href="/static/img/sprite.svg#arrow_upward"></use> </svg> </button> <script src="https://code.jquery.com/jquery-3.5.0.min.js" integrity="sha256-xNzN2a4ltkB44Mc/Jz3pT4iU1cmeR0FkXs4pru/JxaQ=" crossorigin="anonymous"> </script> <script type="text/javascript">var exports = {};</script> <script src="/static/CACHE/js/output.13b077bc3ffd.js"></script> <script type="application/javascript"> window.ncbi = window.ncbi || {}; window.ncbi.pmc = window.ncbi.pmc || {}; window.ncbi.pmc.options = { logLevel: 'INFO', staticEndpoint: '/static/', citeCookieName: 'pmc-cf', }; </script> <script type="module" crossorigin="" src="/static/assets/base-9bea7450.js"></script> <script type="module" crossorigin="" src="/static/assets/article-722d91a2.js"></script> </body> </html>

CINXE.COM

Decreased Portal Vein Velocity is Predictive of the Development of Portal Vein Thrombosis: a Matched Case-Control Study - PMC