Efficacy and safety of reduced thromboprophylaxis with low molecular weight heparin for hepatocellular carcinoma after conversion therapy

Abstract

Background: Tyrosine kinase inhibitors (TKIs) impairs factor Xa (FXa)-mediated coagulation. This study aims to assess the safety and feasibility of reduced thromboprophylaxis with low molecular weight heparin (LMWH) for hepatocellular carcinoma (HCC) converted by Lenvatinib treatment. Methods: One hundred forty consecutive HCC patients who received Lenvatinib standalone therapy before hepatectomy were retrospectively enrolled. Group A received reduced LMWH (≤ 100 IU/kg daily for ≤ 5 days), while Group B received no pharmacologic thromboprophylaxis. Primary outcome was incidence of thrombotic or hemorrhagic complications. Secondary outcome was overall survival (OS). Results: Sixty-two and seventy-four patients were divided into group A and B respectively. The incidence of VTE (4.8% vs. 14.9%, P = 0.091, OR = 0.31, 95% CI: 0.08–1.16) and postoperative hemorrhage (3.2% vs. 9.5%, P = 0.298, OR = 0.34, 95% CI: 0.07–1.69) trended lower in Group A. Conclusion: Limitations include a retrospective design, potential selection bias, and limited statistical power. Our findings suggest a trend toward reduced hemorrhagic and thrombotic risks with reduced LMWH, though statistical significance was not reached (VTE P = 0.091, hemorrhage P = 0.298) reduce such risks in HCC patients after neoadjuvant Lenvatinib and hepatectomy, though limitations like the retrospective design should be noted. Clinically, reduced LMWH prophylaxis offers a safe alternative for high-bleeding-risk patients, guiding surgical teams to balance thrombosis-bleeding risks and informing oncologists’ perioperative anticoagulation strategies. Trial registration: Not applicable.