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

Background: Cirrhotic patients with hepatocellular carcinoma (HCC) exhibit hypercoagulability.

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

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

Results: Seventy-six patients (41 with and 35 without HCC) were included. Vital tumor volume (VTV) was  >5cm in 18 patients. Fibrinogen was higher in HCC patients with VTV>5cm as compared to those with VTV≤5cm 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.

Conclusions: 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.