Characteristics and Impacts of Venous Thromboembolism in Patients with Hepatocellular Carcinoma

Wang, Yuchen; Attar, Bashar M.; Hinami, Keiki; Fuentes, Harry E; Jaiswal, Palashkumar; Zhang, H.; Simons-Linares, C. Roberto; Tafur, Alfonso

doi:10.1007/s12029-017-9945-6

Cited by 14 publications

(23 citation statements)

References 42 publications

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“…On one hand, it would appear that HCC can be associated with an increased risk of VTE. In fact, a recent retrospective analysis evaluated HCC-related thrombophilia in a cohort of 270 cirrhotic patients with HCC [ 55 ] and uncovered a 2-year cumulative incidence of VTE after HCC diagnosis of 5.93% (16 VTEs including 7 PEs, 5 intra-abdominal DVTs, and 4 peripheral DVTs), in line with previous reports on other types of cancers [ 56 ]. Furthermore, most cases (12/16, 75%) occurred within 3 months of the HCC diagnosis (early VTE), suggesting HCC may have tipped the hemostatic balance towards a hypercoagulable state.…”

Section: Thromboembolic Complications In Cirrhotic Patients With Hsupporting

confidence: 78%

“…Do HCC patients who develop VTE have a greater risk of death than their counterparts with no thrombotic complications? Wang et al [ 55 ] estimated the HR for death in patients with VTE at 3.62 (95% CI = 1.22–10.79, p = 0.021 at multivariate analysis), in line with previous data on other types of neoplasms. It remains unclear from a retrospective analysis whether this stemmed solely from the severity of HCC or the thrombotic complication, thus further prospective studies are warranted.…”

Section: Thromboembolic Complications In Cirrhotic Patients With Hsupporting

confidence: 60%

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Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma

Zanetto

Campello

Spiezia

et al. 2018

Cancers

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It is common knowledge that cancer patients are more prone to develop venous thromboembolic complications (VTE). It is therefore not surprising that patients with hepatocellular carcinoma (HCC) present with a significant risk of VTE, with the portal vein being the most frequent site (PVT). However, patients with HCC are peculiar as both cancer and liver cirrhosis are conditions that can perturb the hemostatic balance towards a prothrombotic state. Because HCC-related hypercoagulability is not clarified at all, the aim of the present review is to summarize the currently available knowledge on epidemiology and pathogenesis of non-malignant thrombotic complications in patients with liver cirrhosis and HCC. They are at increased risk to develop both PVT and non-splanchnic VTE, indicating that both local and systemic factors can foster the development of site-specific thrombosis. Recent studies have suggested multiple and often interrelated mechanisms through which HCC can tip the hemostatic balance of liver cirrhosis towards hypercoagulability. Described mechanisms include increased fibrinogen concentration/polymerization, thrombocytosis, and release of tissue factor-expressing extracellular vesicles. Currently, there are no specific guidelines on the use of thromboprophylaxis in this unique population. There is the urgent need of prospective studies assessing which patients have the highest prothrombotic profile and would therefore benefit from early thromboprophylaxis.

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Section: Thromboembolic Complications In Cirrhotic Patients With Hsupporting

confidence: 78%

Section: Thromboembolic Complications In Cirrhotic Patients With Hsupporting

confidence: 60%

Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma

Zanetto

Campello

Spiezia

et al. 2018

Cancers

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“…We then performed multivariate analysis for mortality on PLR, AST and epidemiologic factors predictive of mortality as demonstrated in previous literature, including male gender, advanced HCC, and occurrence of VTE (22,23). All variables remained significantly predictive of mortality (PLR: HR 1.56, P 0.028; AST: HR 1.92, P<0.001) ( Table 4).…”

Section: Association Between Laboratory Values and Mortalitymentioning

confidence: 86%

“…Variables with significance of <0.20 were included in multivariate analysis to identify independent risk factors for mortality. Multivariate analysis was then performed for PLR and epidemiologic factors significantly associated with mortality as demonstrated by prior literature (22,23). Receiver operating characteristics (ROC) curve was plotted for PLR to predict mortality and identify cut-off value by optimized Youden's index.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the prognostic value of platelet to lymphocyte ratio in patients with hepatocellular carcinoma

Wang¹,

Attar²,

Fuentes³

et al. 2017

J. Gastrointest. Oncol.

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“…(5) Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer occurring in patients with cirrhosis, (7) and is associated with a purported increased risk of thrombosis, particularly PVT. (8)(9)(10)(11) Cancer is a well-known risk factor for venous thromboembolism (VTE). (12) Development of VTE in patients with cancer is related to plasmatic hypercoagulability triggered by neoplastic cells with procoagulant activity, host response to cancer, and additional factors such as chemotherapy, immobilization, and infections.…”

mentioning

confidence: 99%

More Pronounced Hypercoagulable State and Hypofibrinolysis in Patients With Cirrhosis With Versus Without HCC

et al. 2021

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In patients with cirrhosis, particularly those with hepatocellular carcinoma (HCC), hypercoagulability may be associated with purported increased risks of portal vein thrombosis and cirrhosis progression. In this study, we extensively investigated hemostatic alterations potentially responsible for the thrombotic tendency in HCC, and evaluated whether such alterations were predictive of hepatic decompensation. Patients with cirrhosis at all stages were prospectively recruited and underwent an extensive hemostatic assessment, including all procoagulant factors and inhibitors, thrombin generation with and without thrombomodulin (TG), profibrinolytic and antifibrinolytic factors, and plasmin-antiplasmin complex. In study part 1 (case control), we compared alterations of coagulation and fibrinolysis in patients with cirrhosis with versus without HCC. In study part 2 (prospective), the subgroup of patients with decompensated cirrhosis was followed for development of further decompensation, and predictors of outcome were assessed by multivariate analysis. One-hundred patients were recruited (50 each with and without HCC). Severity of cirrhosis was comparable between groups. Median HCC volume was 9 cm 3 (range: 5-16). Compared with controls, patients with HCC demonstrated a significantly more prothrombotic hemostatic profile due to increased TG and reduced activation of fibrinolysis, independent of cirrhosis stage. During a median follow-up of 175 days, 20 patients with decompensated cirrhosis developed further episodes of decompensation that were predicted by low FVII and high plasminogen activator inhibitor-1 levels, independent of Model for End-Stage Liver Disease score. Conclusion: Patients with cirrhosis with HCC have profound hyper-coagulable changes that can account for their increased thrombotic tendency. In contrast, hypercoagulability in patients with decompensated cirrhosis is more likely a consequence of chronic liver disease rather than a driver for cirrhosis progression. (Hepatology Communications 2021;0:1-14). P atients with cirrhosis have complex alterations of hemostasis that include low platelet count and increased levels of von Willebrand factor, reduced hepatic synthesis of both procoagulant factors and inhibitors, and altered fibrinolysis. (1) Current theory posits that these alterations result in a rebalanced but precarious hemostatic system that may easily tilt toward either hypocoagulability (increased bleeding tendency) or hypercoagulability (increased clotting tendency).

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Characteristics and Impacts of Venous Thromboembolism in Patients with Hepatocellular Carcinoma

Abstract: Obesity, Child B cirrhosis, more intra-hepatic lesions, and multi-organ extrahepatic metastasis are associated with cancer-associated VTE. VTE will adversely affect the prognosis of patients with HCC; therefore, primary thromboprophylaxis may be warranted in such population.

Cited by 14 publications

References 42 publications

Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma

Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma

Evaluation of the prognostic value of platelet to lymphocyte ratio in patients with hepatocellular carcinoma

More Pronounced Hypercoagulable State and Hypofibrinolysis in Patients With Cirrhosis With Versus Without HCC

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