In PSVD, what specific clinical/imaging or thrombophilia features would make you start pre- emptive anticoagulation before any documented PVT, and how do you monitor for net benefit (thrombosis prevention) versus harm (bleeding) in this population?

Porto-sinusoidal vascular disorder (PSVD) is a more recent umbrella term for a number of manifestations, e.g., nodular regenerative hyperplasia (NRH). There is no pre-emptive benefit to blood thinners. These patients can manifest the usual features of portal hypertension, including portal/splanchnic thromboses. This is the utility of semi-annual ultrasound of the abdomen (which incidentally will image for liver masses, though not by intent), not just ultrasound of the right upper quadrant (RUQ)....