Key result
Radiofrequency ablation for HCC precedes delayed critical bleeding requiring a TIPS procedure.
Why the study?
Restarting anticoagulation after radiofrequency ablation in patients with hepatocellular carcinoma and bleeding risk presents clinical challenges.
Case Report (n=1)
This case highlights that VTE prophylaxis should be routinely initiated immediately following hepatectomy in hemodynamically stable patients without signs of active bleeding, and halted if bleeding occurs.
Answers are grounded in this paper and cite their sources.
Delayed bleeding 6 days post-RFA in HCC warrants caution with antithrombotics; single case leaves optimal prophylaxis timing open.
Restarting anticoagulation is a tricky component of patient care. This is a case of a 65-year-old female presenting with hepatocellular carcinoma. A nonocclusive thrombus in the main portal vein was also identified. Six days postradiofrequency ablation (RFA), the patient's hemoglobin dropped to critical values and noncontrast computed tomography of the abdomen/pelvis revealed high density free fluid consistent with a bleed. The patient was medically managed and accepted for transfer to another hospital for IR-guided TIPS procedure. Patient recovered without any other complications. In conclusion, VTE prophylaxis be routinely initiated immediately following hepatectomy in hemodynamically stable patients without signs of active bleeding and should bleeding occur halt source then restart anticoagulation immediately.
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Adaramola et al. (2020) conducted a case report in Hepatocellular carcinoma and portal vein thrombus (n=1). Radiofrequency ablation and anticoagulation management was evaluated on Delayed bleeding event. A 65-year-old female with hepatocellular carcinoma experienced a critical hemoglobin drop and bleeding 6 days post radiofrequency ablation, requiring medical management and a TIPS procedure.
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