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Francesco Violi - One of the best experts on this subject based on the ideXlab platform.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.
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Portal Vein Thrombosis in liver cirrhosis
2008Co-Authors: Filippo Luca Fimognari, Francesco VioliAbstract:Portal Vein Thrombosis (PVT) is observed in 10–20% of patients with liver cirrhosis, which is responsible for 20% of all PVT cases. The main pathogenic factor of PVT in cirrhosis is the obstacle to Portal flow, but acquired and inherited clotting abnormalities may play a role. The formation of collateral Veins allows many patients to remain asymptomatic and prevents the onset of clinical complications also in patients with totally occlusive PVT. Gastrointestinal bleeding, Thrombosis of superior mesenteric Vein and refractory ascites are typical manifestations of PVT. Instrumental diagnosis can be obtained by colour-doppler ultrasonography. Future studies should verify whether asymptomatic PVT worsens liver failure, or if its life-threatening complications reduce survival in patients with cirrhosis. Moreover, randomized controlled trials should clarify the potential effectiveness of anticoagulant therapy in the treatment of PVT.
Annarita Vestri - One of the best experts on this subject based on the ideXlab platform.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.
Stephen H Caldwell - One of the best experts on this subject based on the ideXlab platform.
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diagnosis development and treatment of Portal Vein Thrombosis in patients with and without cirrhosis
2019Co-Authors: Nicolas M Intagliata, Stephen H Caldwell, Armando TripodiAbstract:Portal Vein Thrombosis unrelated to solid malignancy is common in patients with cirrhosis, but less frequently observed in patients without cirrhosis. Prompt diagnosis and management of acute symptomatic Portal Vein Thrombosis are essential. Failure to detect and treat thromboses can result in mesenteric ischemia, chronic cavernous transformation, and complications of Portal hypertension. In patients with cirrhosis, development of Portal Vein Thrombosis is often insidious and remains undetected until its incidental detection. Management of Portal Vein Thrombosis in patients with cirrhosis is more controversial. However, there are data to support treatment of specific patients with anticoagulation agents. We review the common and distinct features of Portal Vein thromboses in patients without liver tumors, with and without cirrhosis.
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advanced non alcoholic steatohepatitis cirrhosis a high risk population for pre liver transplant Portal Vein Thrombosis
2017Co-Authors: Jonathan G Stine, Curtis K Argo, Shawn J Pelletier, Daniel G Maluf, Stephen H Caldwell, Patrick G NorthupAbstract:Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant Portal Vein Thrombosis
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.
Angelo Gatta - One of the best experts on this subject based on the ideXlab platform.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.
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hepatic arterial resistance in cirrhosis with and without Portal Vein Thrombosis relationships with Portal hemodynamics
1995Co-Authors: David Sacerdoti, Carlo Merkel, Massimo Bolognesi, Piero Amodio, Paolo Angeli, Angelo GattaAbstract:Background/Aims: Little information is available on hepatic arterial hemodynamics in cirrhosis because of the invasiveness of methods. Hepatic arterial resistance indexes were evaluated noninvasively by Doppler ultrasonography and were correlated with Portal hemodynamics evaluated both noninvasively and invasively. Methods: Hepatic arterial resistance indexes, Portal blood flow velocity and volume, and Portal Vein congestion index were evaluated in 31 controls and 171 cirrhotic patients with (n = 13) or without (n = 158) Portal Vein Thrombosis. Resistance to Portal blood flow was also calculated in 15 patients from hepatic venous pressure gradient, measured by hepatic Vein catheterization, and Portal blood flow. Results: Resistance indexes were significantly higher in cirrhotics without Portal Thrombosis than in controls (pulsatility index, 1.30 ± 0.29 vs. 0.89 ± 0.09; P < 0.001; resistive index, 0.71 ± 0.07 vs. 0.59 ± 0.04; P < 0.001). In patients with Portal Thrombosis, the pulsatility index (1.86 ± 0.39) and resistive index (0.81 ± 0.06) were significantly higher than in controls (P < 0.001) and in patients without Thrombosis (P < 0.001). Resistance indexes directly correlated with Portal resistance (P < 0.01), the congestion index (P < 0.01), and the degree of esophageal varices (P < 0.01). Conclusions: Hepatic arterial resistance indexes increase in cirrhosis, particularly with Portal Vein Thrombosis. The pathophysiology of the increase in hepatic arterial resistance seems to be parallel to that of Portal resistance.
M Angelico - One of the best experts on this subject based on the ideXlab platform.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants.
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Portal Vein Thrombosis relevance on liver cirrhosis italian venous thrombotic events registry
2016Co-Authors: Francesco Violi, Stephen H Caldwell, Roberto Gino Corazza, Francesco Perticone, Angelo Gatta, M Angelico, Alessio Farcomeni, Michela Masotti, Laura Napoleone, Annarita VestriAbstract:Portal Vein Thrombosis may occur in cirrhosis; nevertheless, its prevalence, and predictors are still elusive. To investigate this issue, the Italian Society of Internal Medicine undertook the “Portal Vein Thrombosis Relevance On Liver cirrhosis: Italian Venous thrombotic Events Registry” (PRO-LIVER). This prospective multicenter study includes consecutive cirrhotic patients undergoing Doppler ultrasound examination of the Portal area to evaluate the prevalence and incidence of Portal Vein Thrombosis over a 2-year scheduled follow-up. Seven hundred and fifty-three (68 % men; 64 ± 12 years) patients were included in the present analysis. Fifty percent of the cases were cirrhotic outpatients. Viral (44 %) etiology was predominant. Around half of the patients had a mild-severity disease according to the Child–Pugh score; hepatocellular carcinoma was present in 20 %. The prevalence of ultrasound-detected Portal Vein Thrombosis was 17 % (n = 126); it was asymptomatic in 43 % of the cases. Notably, more than half of the Portal Vein Thrombosis patients (n = 81) were not treated with anticoagulant therapy. Logistic step-forward multivariate analysis demonstrated that previous Portal Vein Thrombosis (p < 0.001), Child–Pugh Class B + C (p < 0.001), hepatocellular carcinoma (p = 0.01), previous upper gastrointestinal bleeding (p = 0.030) and older age (p = 0.012) were independently associated with Portal Vein Thrombosis. Portal Vein Thrombosis is a frequent complication of cirrhosis, particularly in patients with moderate–severe liver failure. The apparent undertreatment of patients with Portal Vein Thrombosis is a matter of concern and debate, which should be addressed by planning interventional trials especially with newer oral anticoagulants. Clinicaltrials.gov identifier NCT01470547.