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Peer-reviewedCC BY-NC-ND 4.0BMC Gastroenterology

Right atrial tumour thrombus in hepatocellular carcinoma: a case report and literature review of anticoagulation dilemmas

  • Chu Ee Seow1
  • Julia Hanim Jaafar1
  • Jason Seng Hong Tan1
  • Navin Kumar Santha Moorthy2
  1. 1Department of Internal Medicine, Banting Hospital, Jalan Sultan Alam Shah, Banting, Selangor 42700 Malaysia
  2. 2Department of Radiology, Banting Hospital, Jalan Sultan Alam Shah, Banting, Selangor 42700 Malaysia
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Abstract

Background: Tumour thrombus (TT) extending from the hepatic vein (HV) to the inferior vena cava (IVC) and right atrium (RA) is rare and associated with poor prognosis. The role of anticoagulation in such cases remains controversial, particularly in Child-Pugh C cirrhosis.

Case presentation: A 55-year-old Malay male with Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) and TT extending to the RA was initiated on apixaban due to concerns for risk of thromboembolism. The patient had Child-Pugh class C cirrhosis with a MELD score of 20. Apixaban treatment was not associated with any bleeding complications or any survival or symptomatic benefit, and the patient succumbed to disease progression within nine weeks.

Conclusion: HCC with extensive vascular TT portends a poor prognosis. Anticoagulation in such cases should be individualized by considering the Khorana score, presence of varices, and bleeding risk. Further studies are needed to establish evidence-based strategies.

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Cite

BibTeXRIS
BibTeX
@article{seow2026right,
  title = {{Right atrial tumour thrombus in hepatocellular carcinoma: a case report and literature review of anticoagulation dilemmas}},
  author = {Chu Ee Seow and Julia Hanim Jaafar and Jason Seng Hong Tan and Navin Kumar Santha Moorthy},
  journal = {BMC Gastroenterology},
  year = {2026},
  month = aug,
  doi = {10.1186/s12876-026-05118-4},
  url = {https://doi.org/10.1186/s12876-026-05118-4},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Right atrial tumour thrombus in hepatocellular carcinoma: a case report and literature review of anticoagulation dilemmas
AU  - Chu Ee Seow
AU  - Julia Hanim Jaafar
AU  - Jason Seng Hong Tan
AU  - Navin Kumar Santha Moorthy
PY  - 2026
DA  - 2026/08/07
JO  - BMC Gastroenterology
DO  - 10.1186/s12876-026-05118-4
UR  - https://doi.org/10.1186/s12876-026-05118-4
AB  - Background: Tumour thrombus (TT) extending from the hepatic vein (HV) to the inferior vena cava (IVC) and right atrium (RA) is rare and associated with poor prognosis. The role of anticoagulation in such cases remains controversial, particularly in Child-Pugh C cirrhosis.  Case presentation: A 55-year-old Malay male with Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) and TT extending to the RA was initiated on apixaban due to concerns for risk of thromboembolism. The patient had Child-Pugh class C cirrhosis with a MELD score of 20. Apixaban treatment was not associated with any bleeding complications or any survival or symptomatic benefit, and the patient succumbed to disease progression within nine weeks.  Conclusion: HCC with extensive vascular TT portends a poor prognosis. Anticoagulation in such cases should be individualized by considering the Khorana score, presence of varices, and bleeding risk. Further studies are needed to establish evidence-based strategies.
SN  - 1471-230X
ER  -