To the Editor, Portal vein thrombosis (PVT), defined as thrombosis of the main portal vein (PV), or its branches or the splenic vein (SV) or superior mesenteric vein (SMV) of the splenoportal axis, is a well-known complication of the hypercoagulable state of cirrhosis. 1 However, thrombosis of deep veins, pulmonary microcirculation, and arterial thrombosis has also been reported as a consequence of COVID-19 infection or vaccination. 2 The post-COVID-19 thrombophilia is of great relevance in hepatology practice as it predisposes to PVT related increased portal pressures and variceal bleeding, hepatic venous outflow tract obstruction, or post-transplant vascular complications. 3

Herein we report six cases of new-onset PVT, who were on hepatocellular carcinoma (HCC) surveillance imaging and were diagnosed with new main PVT or branch PVT following COVID 19 infection in three cases and following vaccination with ChAdOx1 nCoV-19 Coronavirus vaccine (recombinant) in three cases. The surveillance protocol at our institute is based on Ultrasound Doppler imaging every 3 months and a semi-annual triple computed tomography (CT) or magnetic resonance imaging (MRI). All 6 patients had confirmed PVT on either CT or MRI (Table 1). The mean time since the last screening imaging was 95+ 22.5 days.