Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. Decreased portal vein velocity is the most important risk factor for cirrhotic PVT, and the etiology and severity of liver cirrhosis, hemostasis status, and inflammatory and immune mechanisms may also be associated with the development of cirrhotic PVT. The natural history of cirrhotic PVT includes improvement, stabilization, progression, and recurrence. Non-occlusive PVT and improvement of liver function may be associated with spontaneous improvement of cirrhotic PVT. The impact of different occlusion degree of cirrhotic PVT on patients' prognosis is inconsistent. Non-occlusive PVT may not significantly affect patients' outcomes; occlusive PVT may increase the risk of death, and PVT involving the mesenteric veins may also lead to intestinal ischemia and infarction. Clinical management strategies for cirrhotic PVT include wait-and-see strategy (no intervention), anticoagulation, thrombolysis, and transjugular intrahepatic portosystemic shunt (TIPS). When the degree of PVT is less than 50% and the mesenteric veins are not involved, immediate intervention may not be required. Anticoagulation is the first-line choice for cirrhotic PVT requiring treatment. Thrombolysis and TIPS are mainly used for patients with contraindications of anticoagulation and those who do not respond to anticoagulation. This paper reviews the clinical assessment of cirrhotic PVT and its predictors, natural history, impact on prognosis, treatment, and prophylaxis.