Table 1.
Thromboembolic complications in cirrhotic patients with hepatocellular carcinoma.
| Author, Years [Ref] | Type of Study | Population | Method for Thrombosis Diagnosis | Incidence of Thrombotic Complications | Statistical Significance |
|---|---|---|---|---|---|
| Portal Vein Thrombosis (PVT) | |||||
| Nonami, 1992 [32] | Retrospective, single center | - 87 patients with cirrhosis and HCC - 401 patients with post-necrotic liver cirrhosis Autoptic population |
Examinations of excised livers at the time of LT | 30/87 (34.8%) vs. 63/401 (15.7%) | NA |
| Davidson, 1994 [33] | Prospective, single center | - 22 patients with cirrhosis and HCC - 110 patients non-HCC cirrhosis LT candidates |
Operative finding at the time of LT | 6/22 (27.3%) vs. 10/110 (9.1%) | <0.05 |
| Ravaioli, 2011 [34] | Retrospective, single center | - 282 patients with cirrhosis and HCC LT candidates |
Operative finding at the time of LT | 37/282 (11%) | HCC significantly associated with PVT risk at multivariate analysis (HR: 1.81; p < 0.05) |
| Zanetto, 2017 [19] | Prospective, single center (1-year f-up) |
- 41 patients with cirrhosis and HCC - 35 patients with non-HCC cirrhosis Both compensated and decompensated patients |
Splanchnic Doppler ultrasound and subsequently characterized by CT/MRI | 10/41 (24.4%) vs. 4/35 (11.4%) | 0.05 |
| Extra-Splanchnic Thromboembolic Complications | |||||
| Levitan, 1999 [36] | Retrospective, US Medicare data | - 22,938 patients with discharge diagnosis of liver cancer 1988–1990 | Subsequent discharge diagnosis of DVT/PE | 121/22,938 = 69 per 10,00 patients | Intermediate risk (same risk of lung cancer) |
| Wun, 2009 [37] |
Retrospective, California Discharge data |
- 2312 patients with discharge diagnosis of liver cancer 1993–1999 | Subsequent discharge codes for VTE | 1-year cumulative incidence 1.7% 1-year rate 4.1%/100 patients-years |
- Intermediate risk (same risk as lung cancer) - Correlation between 1-year death rate and VTE incidence |
| Cronin-Fenton, 2010 [38] |
Retrospective, Danish medical record data |
- 550 patients with diagnosis of liver cancer 1997–2005 - general population cohort |
Subsequent diagnosis code for VTE | 6/550 (1.1%) vs 11/2746 (0.4%) | High risk |
| Connolly, 2008 [5] | Retrospective, single center | - 194 consecutive patients with cirrhosis and HCC | Splanchnic Doppler ultrasound and CT/MRI at the time of LT; VTE not specified | 6.7% Most of VTEs (7, 63%) were DVTs |
PVT patients had a higher rate of systemic VTE vs non-PVT patients |
| Lesmana, 2010 [45] | Case control, single center | - 87 patients with cirrhosis and HCC- 169 cirrhotic patients without HCC | Lower limb Doppler ultrasound in the presence of clinical symptoms | 4/87 (4.6%) vs 8/169 (4.7%) * | 0.6 |
| Wang, 2018 [55] | Retrospective, single center | - 270 consecutive patients with cirrhosis and HCC Both compensated and decompensated patients |
Lower limb Doppler ultrasound, thoracic CT scan | 6% (2-years cumulative incidence) 12/16 (75%) early VTE |
>3 hepatic lesions vs single lesion (HR = 3.6, p < 0.05); multi-organ extra-hepatic metastasis (HR = 12; p < 0.05) significantly associated with VTE risk at multivariate analysis |
NA: not available; DVT: deep vein thrombosis; PE: pulmonary embolism; HCC: hepatocellular carcinoma; LT: liver transplant; VTE: venous thromboembolism; PVT: portal vein thrombosis; HR: hazard ratio; DVT: deep vein thrombosis; CT: computed tomography; MRI: magnetic resonance imaging. * Only cases of deep vein thrombosis were included in the analysis.