Anticoagulation For Portal Vein Thrombosis in Patients With Hepatocellular Carcinoma: A Retrospective Observational Study
Journal of Clinical Oncology
Background: Portal vein thrombosis (PVT) occurs in 10-40% of patients with hepatocellular carcinoma (HCC). Advanced imaging modalities, such as MRI, can differentiate between bland PVT and tumor thrombus, and help determine the need for anticoagulation (AC). Our study aims to assess the use of AC in patients with HCC and concomitant PVT. Methods: We conducted a retrospective observational study at eight hospitals in a community healthcare system in southeast Michigan. Patients with a combined diagnosis of HCC and PVT were identified between August 2016 and September 2022. Demographics, clinical characteristics, use of AC, type of thrombus, and median survival were collected through chart review. Results: A total of 122 patients were diagnosed with HCC and PVT (17 patients were lost to follow-up). The median age at diagnosis was 72.7 years and 77.1% of patients were male. Majority (66.6%) of patients were white. Underlying cirrhosis was present in 85.7% of patients, of which 41% was due to HCV infection. Around half of the patients had a Child-Pugh Class-B at diagnosis. AC was started in 46% of patients, with apixaban being the most commonly used agent (56%). Imaging results in the AC group confirmed that 52% of patients had a tumor thrombus. Of all the patients started on AC, 25% had bleeding complications. Overall, death occurred in 52.1% of patients in the AC group compared to 57.9% of patients who did not receive AC. Median survival was 6 months in both groups (p=0.7). Using cox-proportional hazards model, there was no difference observed in overall survival between patients who received AC and patients who did not (HR 0.91, 95% CI 0.54-1.53, p=0.72). Conclusions: In this retrospective review of patients with HCC and PVT, no difference in survival was observed between patients who received AC and patients who did not receive AC. Further randomized prospective data are needed to guide management in this high-risk patient group.
Antonios K, Antonios B, Al-Banaa K, Chisti MM. Anticoagulation for portal vein thrombosis in patients with hepatocellular carcinoma: a retrospective observational study. J Clin Oncol. 2023 Jun;41(16 Suppl.):e16212. doi:10.1200/JCO.2023.41.16_suppl.e16212 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) e16212-e16212
10.1200/JCO.2023.41.16_suppl.e16212 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) e16212-e16212