PB1408 - Incidence and determinants of venous thromboembolic and bleeding complications in patients with hepatocellular carcinoma – the Tityos study

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Emily S.L Martens, MD

PhD student
Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Suzanne C. Cannegieter

MD, PhD, prof
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Leiden, Zuid-Holland, Netherlands
MC

Minneke J. Coenraad

MD, PhD
Department of Gastroenterology - Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
Leiden, Zuid-Holland, Netherlands
MH

Menno V. Huisman

Professor of Medicine
Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
Leiden, Zuid-Holland, Netherlands
JL

Jenny N.J. Le

Medical student
Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Leiden, Zuid-Holland, Netherlands
Tv

Tom van der Hulle

MD, PhD
Department of Medicine – Division of Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Leiden, Zuid-Holland, Netherlands
MT

Maarten E. Tushuizen

MD, PhD
Department of Gastroenterology - Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
Leiden, Zuid-Holland, Netherlands
SZ

Sanne Zweekhorst

Medical student
Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Leiden, Zuid-Holland, Netherlands
Henri Versteeg, PhD

Professor
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center

Background: Hepatocellular carcinoma (HCC) patients are considered at high risk for both venous thromboembolism (VTE) and bleeding because of the central role of the liver in hemostasis. However, reliable data on the incidence estimates are lacking.

Aims: To assess the cumulative incidence of VTE and major bleeding (MB) at 6 and 12 months, its predictors and the impact on all-cause mortality.

Methods: Single-center cohort study of patients diagnosed with HCC between 2010 and 2022. Patients were followed from diagnosis for one year, or earlier if an outcome of interest (VTE, MB or death) occurred, depending on the analysis. Cumulative incidences were estimated with death and loss-to-follow-up from palliative/end-of-life care as competing risks. Cox regression was used to identify predictors of the outcomes of interest and their impact on prognosis.

Results: 518 patients were included of whom 75% had liver cirrhosis; 16% died and 22% were lost-to-follow-up (Table 1).
The 6-month cumulative incidence of VTE was 7.4% (95%CI 5.1-9.7); 4.7% splanchnic vein thrombosis (SVT) and 2.5% extra-splanchnic VTE including 1.8% usual sites (i.e., deep vein thrombosis and pulmonary embolism). The 12-month cumulative incidence of VTE was 11% (95%CI 8.2-14); 7.7% SVT and 3.2% extra-splanchnic VTE including 2.1% usual-site VTE.
The 6- and 12-month cumulative incidence of MB was 12% (95%CI 9.4-15) and 16% (95%CI 13-20), respectively. Nineteen patients (24%) received therapeutic anticoagulation at time of bleeding.
In univariate analyses, increasing age was associated with a reduced risk of VTE (Table 2). For MB, no predictors were identified. Poorer performance status, higher tumor stage and Child-Pugh classes were associated with mortality, as were VTE and MB, the latter two with an aHR of 2.6 (95%CI 1.4-5.0) and 3.1 (95%CI 1.8-5.3).

Conclusion(s): We found high incidences of both MB and VTE in HCC patients, with SVT being the most common site. Both complications were associated with poorer survival.