Porto-sinusoidal vascular disorder (PSVD) involves structural damage to small portal veins in the liver, causing narrowing or blockage. These changes lead to reduced blood flow, liver cell atrophy, and nodular regenerative hyperplasia. Portal vein thrombosis (PVT) occurs in 13–45% of PSVD patients over time. Up to 18% of patients have inherited or acquired clotting disorders that increase risk. Long-term studies show PVT risk rises progressively, reaching about 30% at 10 years.
Current guidelines recommend at least 6 months of anticoagulation, with longer treatment in high-risk patients. It is uncertain whether anticoagulation should continue after full vein recanalization. The role of reduced-dose direct oral anticoagulants (DOACs) in preventing recurrence is still unclear. More multicenter studies are needed to determine the safest and most effective long-term treatment strategies.