Platelet function changes as a risk factor for hepatocellular carcinoma development in patients with liver cirrhosis

Purpose
This study aimed to investigate the relationship between alterations in platelet function and risk of hepatocellular carcinoma (HCC) development in patients with cirrhosis.


Patients and methods
This case–control study included 120 participants: 40 patients with cirrhosis, 50 patients with HCC, and 30 age-matched and sex-matched healthy controls. Routine clinical and laboratory investigations were performed for all participants, and platelet aggregation was evaluated by light transmission aggregometry, using adenosine diphosphate (ADP) and ristocetin as platelet agonists. Additionally, the concentration of von Willebrand factor (vWF) was assayed using enzyme-linked immunosorbent assay.


Results
Platelet aggregation profiles were significantly decreased in all patients with liver cirrhosis (with and without HCC) compared with healthy controls (P<0.001). However, comparing both patient groups, the platelet aggregation was significantly higher in HCC patients than in those without HCC. Similarly, vWF levels were significantly elevated in both patients compared to controls and were higher in the HCC group (161.6 ng/ml) than in those without HCC (80.34 ng/ml). Univariate analysis revealed that HCC was significantly associated with age, platelet/splenic diameter, ascites, platelet count, creatinine, ADP-induced platelet aggregation, and vWF concentration. Multivariate analysis revealed that ADP-induced platelet aggregation was an independent risk factor and a predictor of HCC development.


Conclusion
HCC is associated with increased platelet aggregation and vWF levels. ADP-induced platelet aggregation was independently associated with HCC development. The change in platelet aggregation could be a useful risk factor for HCC development and thus raises attention to implicate platelet function tests in the follow-up of these patients.