How do you decide between anticoagulation or portal vein recanalization in a patient with portal vein thrombosis?

It depends on cirrhotic vs non-cirrhotic.

For cirrhotic, best to reference the AASLD 2020 guidance here - Northup et al., PMID 33219529.

For non-cirrhotic: important to determine the etiology as well as evaluate for a hypercoagulable state, including checking for JAK2 and CALR.

If acute and non-occlusive PVT, then anticoagulation along with surveillance cross-sectional imaging (CT preferred) in 3-6 months is reasonable.

For acute, completely occlusive, invasive options such as IR thrombectomy, may ...