Table 1.
Clinical Characteristics of the 6 Patients Who Presented with New Onset PVT.
| Patient Details | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 |
|---|---|---|---|---|---|---|
| Age (Years) | 38 | 45 | 53 | 55 | 56 | 48 |
| Sex | Male | Male | Male | Female | Female | Male |
| Etiology of Liver Disease | Ethanol | Ethanol | Ethanol | HCV | NAFLD | NAFLD |
| Co morbidity | None | Hypertension | None | None | Diabetes mellitus | Diabetes mellitus |
| COVID19 Infection | Yes | Yes | No | Yes | Yes | No |
| Severity of COVID-infection | Mild | Moderate (Oxygen requiring) | Moderate (Oxygen requiring) | Mild | ||
| Vaccination | No | No | Yes | Yes | No | Yes |
| Number of doses received | 1 | 1 | 2 | |||
| Use of anticoagulation in the last 6 months | No | No | No | Yes. 5 days of LMW heparin. | No | No |
| Use of Steroids in the last 6 months | No | No | No | No | Yes | No |
| Time period between COVID19 to detection of PVT (Days) | 70 | 90 | NA | 90 | 60 | NA |
| Time period between COVID19 vaccination to detection of PVT (Days) | NA | NA | 110 | 60 | NA | 90 |
| Time period between date of last surveillance ultrasound Doppler examination till detection of new PVT (Days) | 120 | 90 | 60 | 90 | 90 | 120 |
| PVT | Main | Main | Eccentric PVT | Branch | Main | Main |
| SMVT | No | No | Yes | No | No | No |
| ST | No | No | Yes | No | No | No |
| Presentation | Pain | Variceal Bleeding | Pain | Increasing ascites | Variceal Bleeding | New onset ascites |
| Other Decompensation | Ascites | Hepatic Encephalopathy | Ascites | |||
| CTP | 9 | 9 | 9 | 12 | 13 | 12 |
| MELDNa | 11 | 13 | 14 | 15 | 18 | 18 |
| COVID antibody titre (CLIA) | 14.9 | 12.5 | Not done | 8.5 | Not done | 7.45 |
| JAK2 mutation | Negative | Negative | Negative | Negative | Negative | Negative |
| Factor V Leiden mutation | Negative | Negative | Negative | Negative | Negative | Negative |
| Treatment | On Variceal Eradication | On Variceal Eradication | On Dabigatran | Expired due to secondary sepsis, bacterial pneumonia | Expired due to systemic sepsis, difficult to treat SBP. | On variceal eradication |
| Hill’s Criteria | ||||||
| Temporality | ++ | ++ | ++ | ++ | ++ | ++ |
| Biological Plausibility | + | + | ++ | + | + | ++ |
| Likelihood of causal relationship with Vaccine | Probable association | Possible association | Probable association | |||
Abbreviations: CTP, Child Turcotte Pugh score; CLIA, chemiluminescent immunoassay; JAK2, Janus kinase 2 gene mutation; PVT, portal vein thrombosis; LMWH, low molecular weight heparin; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease; SBP, spontaneous bacterial peritonitis.