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Zanetto A, Campello E, Spiezia L, et al. Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma. Cancers (Basel). 2018;10(11)doi: 10.3390/cancers10110450.
Zanetto, A., Campello, E., Spiezia, L., Burra, P., Simioni, P., & Russo, F. P. (2018). Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma. Cancers, 10(11), . https://doi.org/10.3390/cancers10110450
Zanetto, Alberto, et al. "Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma." Cancers vol. 10,11 (2018). doi: https://doi.org/10.3390/cancers10110450
Zanetto A, Campello E, Spiezia L, Burra P, Simioni P, Russo FP. Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma. Cancers (Basel). 2018 Nov 16;10(11). doi: 10.3390/cancers10110450. PMID: 30453547; PMCID: PMC6266984.
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Cancers (Basel). 2018 Nov 16;10(11). doi: 10.3390/cancers10110450.

Cancer-Associated Thrombosis in Cirrhotic Patients with Hepatocellular Carcinoma.

Cancers

Alberto Zanetto, Elena Campello, Luca Spiezia, Patrizia Burra, Paolo Simioni, Francesco Paolo Russo

Affiliations

  1. Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy. [email protected].
  2. Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, 35128 Padua, Italy. [email protected].
  3. Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, 35128 Padua, Italy. [email protected].
  4. Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy. [email protected].
  5. Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, 35128 Padua, Italy. [email protected].
  6. Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy. [email protected].

PMID: 30453547 PMCID: PMC6266984 DOI: 10.3390/cancers10110450

Abstract

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.

Keywords: cancer; hepatocellular carcinoma; hypercoagulability; portal vein thrombosis; venous thromboembolism

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