title: Thromboelastometry hypercoagulable profiles and portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Cirrhotic patients with hepatocellular carcinoma (HCC) exhibit hypercoagulability.
  
  
  OBJECTIVE
  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  >5cm3in 18 patients. Fibrinogen was higher in HCC patients with VTV>5cm3as compared to those with VTV≤5cm3and 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.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanetto
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy. Electronic address: marcosenzolo@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.affiliation: Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Radu
authors.affiliation: Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sartorello
authors.affiliation: Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.affiliation: Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Campello
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Kryssia
authors.initials: K
authors.lastname: Rodriguez-Castro
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrarese
authors.affiliation: Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.affiliation: Thrombosis and Haemorrhagic Diseases Unit, Thrombophilia and Haemophilia Center, Department of Medicine, Padua University Hospital, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011169:Portal Vein / Q000473:pathology; D016016:Proportional Hazards Models; D012307:Risk Factors; D013916:Thrombelastography / Q000379:methods*; D020246:Venous Thrombosis / Q000453:epidemiology*
keywords: Hepatocellular carcinoma; Liver cirrhosis; Portal vein thrombosis; Thromboelastometry