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Portal vein thrombosis (PVT) in the cirrhotic population is a challenging clinical phenomenon requiring a nuanced management approach. Uncertainty exists regarding the clinical significance of PVT in the cirrhotic population because the data for PVT are based mainly on retrospective, small cohort studies. Therefore, strong recommendations regarding the optimal timing, modality, and duration of therapy for PVT in the cirrhotic population cannot be made. However, this review aims to summarize the current literature and provide stepwise guidance in diagnosing and managing PVT in patients with cirrhosis.