Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy.
General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, Padova University Hospital, Padova, Italy.
Liver Int. 2022 Jun;42(6):1229-1240. doi: 10.1111/liv.15183. Epub 2022 Feb 21.
Venous thrombosis is a frequent complication in cancer and is associated with high morbidity and mortality. Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related death worldwide, and it is associated with preexisting cirrhosis in 90% of cases. Patients with cirrhosis acquire complex alterations in their haemostatic system that may predispose them to bleed or thrombotic complications. There is growing evidence that HCC may tilt the haemostatic equilibrium in cirrhosis towards hypercoagulability, thus increasing the risk of venous thrombosis. Previously described mechanisms of HCC-driven thrombophilia include thrombocytosis and increased platelet activation/function, increased fibrinogen concentration/polymerization, enhanced thrombin generation, hypofibrinolysis, and release of tissue factor-expressing microvesicles. Nevertheless, there are currently no specific guidelines on risk stratification and management of thromboprophylaxis in patients with cirrhosis and HCC. Our review endeavours to summarize the latest findings on epidemiology, risk factors and pathogenesis of non-malignant venous thrombosis in patients with cirrhosis and HCC, and provide evidence in support of tailored management of thrombotic risk in these patients.
静脉血栓栓塞是癌症的常见并发症，与高发病率和死亡率相关。肝细胞癌（HCC）是最常见的原发性肝癌，也是全球癌症相关死亡的主要原因，在 90%的病例中与先前存在的肝硬化相关。肝硬化患者的止血系统会发生复杂的改变，这可能使他们容易发生出血或血栓并发症。越来越多的证据表明，HCC 可能使肝硬化中的止血平衡向高凝状态倾斜，从而增加静脉血栓形成的风险。先前描述的 HCC 导致血栓形成倾向的机制包括血小板增多和血小板激活/功能增加、纤维蛋白原浓度/聚合增加、凝血酶生成增强、纤溶功能降低以及表达组织因子的微囊泡释放。然而，目前尚无针对肝硬化和 HCC 患者血栓预防的风险分层和管理的具体指南。我们的综述旨在总结肝硬化和 HCC 患者非恶性静脉血栓形成的最新流行病学、危险因素和发病机制的研究结果，并提供支持这些患者血栓风险个体化管理的证据。
