Alberto Zanetto1, Marco Senzolo2, Alessandro Vitale3, Umberto Cillo3, Claudia Radu4, Francesca Sartorello4, Luca Spiezia4, Elena Campello4, Kryssia Rodriguez-Castro1, Alberto Ferrarese1, Fabio Farinati5, Patrizia Burra1, Paolo Simioni4. 1. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy. 2. Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy. Electronic address: marcosenzolo@hotmail.com. 3. Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy. 4. Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy. 5. Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
Abstract
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 >5cm3 in 18 patients. Fibrinogen was higher in HCC patients with VTV>5cm3 as compared to those with VTV≤5cm3 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.
BACKGROUND:Cirrhoticpatients 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, cirrhoticpatients 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 >5cm3 in 18 patients. Fibrinogen was higher in HCC patients with VTV>5cm3 as compared to those with VTV≤5cm3 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.
Authors: Peter J Lawson; Hunter B Moore; Ernest E Moore; Mark E Gerich; Gregory R Stettler; Anirban Banerjee; Richard D Schulick; Trevor L Nydam Journal: J Surg Res Date: 2018-06-08 Impact factor: 2.192
Authors: Klaus Görlinger; Antonio Pérez-Ferrer; Daniel Dirkmann; Fuat Saner; Marc Maegele; Ángel Augusto Pérez Calatayud; Tae-Yop Kim Journal: Korean J Anesthesiol Date: 2019-05-17
Authors: Alberto Zanetto; Elena Campello; Luca Spiezia; Patrizia Burra; Paolo Simioni; Francesco Paolo Russo Journal: Cancers (Basel) Date: 2018-11-16 Impact factor: 6.639