Hepatocellular carcinoma (HCC) is characterized by a complex disruption of hemostatic balance, increasing the risk of both thrombotic and hemorrhagic events. Thrombotic complications, most notably portal vein thrombosis (PVT) and venous thromboembolism (VTE), have a significant impact on clinical outcomes and therapeutic strategies. Cirrhosis contributes to the precarious equilibrium between pro- and anticoagulant forces through impaired synthesis of coagulation factors, endothelial dysfunction, and systemic inflammation. In the presence of HCC tumor-driven mechanisms, such as tissue factor expression, extracellular vesicle release, platelet activation, and suppression of fibrinolysis exacerbate this prothrombotic state. In this scenario, advanced diagnostic tools such as thrombin generation assay (TGA) and rotational thromboelastometry (ROTEM) offer a more accurate assessment of coagulation dynamics than conventional tests, enabling better risk stratification especially for therapeutic purposes. Anticoagulant therapy has demonstrated clinical benefit in selected cases of non-malignant PVT and VTE, particularly when liver function is preserved. While prophylactic strategies are still under investigation, data suggest they may be safely implemented in selected surgical patients. In the setting of immunotherapy, especially regimens involving anti-VEGF agents, anticoagulation may be considered with careful management of bleeding risk due to portal hypertension. An individualized approach to anticoagulation, supported by functional coagulation testing, is gaining acceptance as a means to safely reduce thrombotic burden and potentially improve outcomes in patients with HCC.
肝细胞癌（HCC）的特征是止血平衡的复杂紊乱，增加了血栓形成和出血事件的风险。血栓并发症，尤其是门静脉血栓（PVT）和静脉血栓栓塞（VTE），对临床结局和治疗策略具有显著影响。肝硬化通过凝血因子合成受损、内皮功能障碍和全身性炎症，导致促凝与抗凝力量之间处于不稳定平衡状态。在HCC存在的情况下，肿瘤驱动机制（如组织因子表达、细胞外囊泡释放、血小板激活以及纤溶抑制）加剧了这种促血栓状态。在此背景下，与常规检测相比，凝血酶生成试验（TGA）和旋转血栓弹力测定法（ROTEM）等先进诊断工具能更准确地评估凝血动态，从而实现更好的风险分层，尤其有助于治疗决策。抗凝治疗在选定的非恶性PVT和VTE病例中已显示出临床获益，尤其在肝功能保留的情况下。虽然预防性策略仍在研究中，但数据表明其可在选定的手术患者中安全实施。在免疫治疗背景下，尤其是涉及抗VEGF药物的方案中，可考虑抗凝治疗，但需谨慎管理门脉高压相关的出血风险。基于功能性凝血检测支持的个体化抗凝策略，正逐渐被接受为一种安全减轻HCC患者血栓负荷并可能改善预后的方法。
肿瘤(癌症)患者之家