Reply To: Anticoagulation options with platelets

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Xingshun Qi

Thank you for your further information.

Supporting point for long-term anticoagulation is an occlusive PVT. Spontaneous recanalization is difficult. I remember a case report by Prof. Garcia-Pagan in J Hepatol showing a complete recanalization for CTPV after long-term anticogulation.

Opposing points for long-term anticoagulation are negative thrombophilia, without mesenteric vein involvment, non-LT listed, and a low PLT. Indeed, you can find that a majority of patients included in published studies regarding anticoagulation for PVT do not have a low PLT. So your hematologist’ considerations are reasonable.

Generally, no high-level evidence has been provided, especially in INCPH. Regardless of your final decision, a close monitoring is very necessary. For anticoagulation, please monitor the bleeding risk. For non-anticoagulation, please monitor thrombus progression.