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Thrombotic risk in hepatitis C: Interplay between hepatic dysfunction, viral-driven inflammation, and cardiovascular

Mohammed Zohery1, Sarah Jahangir2, Hamed Carter Jenna2

  • 1George Washington School of Medicine and Health Sciences, The George Washington University, Washington, DC 20052, United States.

World Journal of Virology
|January 2, 2026
PubMed

Insights

Hepatitis C virus (HCV) infection causes systemic inflammation and increases thrombosis risk. Direct-acting antivirals improve outcomes, but ongoing surveillance is vital for high-risk patients.

Area of Science:

  • Hepatology
  • Vascular Biology
  • Infectious Diseases

Background:

  • Hepatitis C virus (HCV) is increasingly recognized as a systemic disease, not just a liver-specific condition.
  • Chronic HCV infection establishes a pro-inflammatory and pro-thrombotic state, elevating risks for venous and arterial thrombotic events.
  • This systemic impact involves endothelial dysfunction, platelet activation, coagulation imbalance, and immune-mediated vascular injury.

Purpose of the Study:

  • To review the complex interplay between chronic Hepatitis C virus infection, systemic inflammation, and thrombotic complications.
  • To highlight the mechanisms driving virus-induced coagulopathy and its clinical manifestations.
  • To emphasize the impact of direct-acting antiviral (DAA) therapy and the need for continued risk assessment.

Main Methods:

  • Literature review of studies on Hepatitis C virus, thrombosis, inflammation, and endothelial function.
  • Analysis of clinical manifestations and mechanistic pathways linking HCV to thrombotic events.
  • Evaluation of the impact of direct-acting antiviral therapy on systemic complications.

Main Results:

  • Chronic HCV infection promotes a pro-thrombotic state through endothelial dysfunction, platelet activation, and coagulation/fibrinolysis imbalance.
  • Clinical manifestations include portal vein thrombosis, venous thromboembolism, coronary artery disease, and ischemic stroke.
  • Direct-acting antiviral therapy effectively reduces inflammation and thrombotic risks, but high-risk patients require ongoing monitoring.

Conclusions:

  • Hepatitis C virus infection is a systemic condition with significant thrombotic implications, challenging the traditional view of cirrhosis.
  • Effective treatment with DAAs can reverse many systemic effects, but residual risk persists in advanced disease.
  • Integrating thrombotic risk assessment into HCV patient care is crucial for comprehensive management.

Keywords:
Cardiovascular diseaseCoagulation imbalanceCryoglobulinemiaDirect-acting antiviralsEndothelial dysfunctionHepatitis C virusPortal vein thrombosisSystemic inflammationThrombotic riskVenous thromboembolism

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