Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?   

No. Anti-coagulation is generally not indicated. Anti-coagulation is usually only indicated for acute PVT causing symptoms. This is more common with underlying thrombophilia. PVT is very common in cirrhosis and anti-coagulation is not required. PV thrombus from tumor similarly is common and anti-coa...

In HCC, portal vein thrombosis can be due to tumor or bland thrombus, or both. Prior to anticoagulating anyone, I usually confirm with the radiologist whether the thrombus is most likely to be tumor thrombus (more likely in HCC) or bland (more likely in other diseases). PVT from HCC enhances similar...

This used to be my philosophy, but this article has made me wonder if we shouldn't be more aggressive. Valeriani et al., PMID 32911539. Also, we will soon start anticoagulating outpatient cancer patients with high risk for VTE with prophylactic anticoagulation per recent changes in guidelines. Lyman...