Right Atrial Tumour Thrombus in Hepatocellular Carcinoma: A Fatal Case and Literature Review of Anticoagulation Controversies

Background: Tumour thrombus (TT) extending from the hepatic vein (HV) to the inferior vena cava (IVC) and right atrium (RA) is a rare and aggressive complication of hepatocellular carcinoma (HCC). Case Presentation: A 55-year-old male presented with abdominal discomfort and mild ascites. Imaging revealed multifocal liver masses and TT extending from the right HV into the IVC and RA. Laboratory findings were consistent with Child-Pugh C cirrhosis and elevated alpha-fetoprotein. The patient was started on antiviral therapy and anticoagulation with apixaban due to RA thrombus. His condition rapidly deteriorated, and he succumbed nine weeks after the diagnosis. Conclusion: HCC with extensive vascular TT portends a poor prognosis. Anticoagulation in such cases should be individualized, and further research is needed to establish evidence-based strategies.