Thromboelastometry hypercoagulable profiles and portal vein thrombosis in cirrhotic patients with hepatocellular...

Cirrhotic patients with hepatocellular carcinoma (HCC) exhibit hypercoagulability.

We investigated whether thromboelastometry can detect hypercoagulability in these patients and the association with portal vein thrombosis (PVT).

At baseline, cirrhotic patients with and without HCC underwent thromboelastometry. PVT onset was recorded over a 12-month follow-up period.

Seventy-six patients (41 with and 35 without HCC) were included. Vital tumor volume (VTV) was  >5cm³ in 18 patients. Fibrinogen was higher in HCC patients with VTV>5cm³ as compared to those with VTV≤5cm³ and those without HCC. Mean platelet count was significantly increased in HCC patients compared with non-HCC. At baseline thromboelastometry, HCC patients showed shorter CTF and higher MCF than non-HCC. PVT incidence was 24,4% and 11.4% in patients with (10/41) and without (4/35) HCC, respectively. Among HCC, 50% of PVT occurred in Child A patients. In HCC, FIBTEM MCF>25mm was associated with a 5-fold increased PVT risk [RR: 4.8 (2-11.3); p=0.0001]. Cox multivariate analysis confirmed HCC and increased MCF (FIBTEM) to be independently associated with increased PVT risk.

Hypercoagulability in HCC which can be detected by thromboelastometry is associated with increased risk of PVT even in Child A patients. The clinical implication of these findings deserves further investigation.