Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function

Background Patients with primary liver cancer (PLC) often present with complex coagulation disorders due to underlying liver disease. Conventional coagulation tests inadequately reflect the comprehensive hemostatic status. This study aimed to investigate the clinical characteristics of thromboelastography (TEG) parameters in PLC patients and evaluate their value in assessing coagulation function. Methods We retrospectively enrolled 1670 PLC patients who underwent surgical treatment at The Third People's Hospital of Yunnan Province between January 2020 and December 2025. Patients were stratified by cirrhosis status (non-cirrhosis, n = 348; cirrhosis, n = 1322), hepatitis B virus (HBV) infection status (HBV-infected, n = 1389; non-HBV-infected, n = 281), and liver disease severity based on Child-Pugh class, MELD score, and indocyanine green retention rate at 15 min (ICGR15). TEG parameters (R time, K time, α-angle, maximum amplitude [MA], coagulation index [CI]) and conventional coagulation tests were measured. Statistical analyses included t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis H tests, chi-square tests, and Spearman correlation analyses. Results Among cirrhotic patients (n = 1322), 1102 were Child-Pugh class A and 220 class B; 1084 had MELD score < 10 and 238 ≥ 10; 906 had ICGR15 < 10% and 416 ≥ 10%. Compared to Child-Pugh A patients, class B patients exhibited significantly prolonged K time, and reduced α-angle, MA, and CI (all P < 0.001). Similar trends were observed in patients with MELD score ≥ 10 versus < 10, and ICGR15 ≥ 10% versus < 10% (all P < 0.001). MA showed strong positive correlations with fibrinogen (r = 0.681, P < 0.001) and platelet count (r = 0.672, P < 0.001). MA was weakly negatively correlated with Child-Pugh score (r=-0.118, P < 0.001), MELD score (r=-0.256, P < 0.001), and ICGR15 (r=-0.121, P < 0.001). HBV-infected patients demonstrated significantly higher MA and CI compared to non-HBV-infected patients (both P < 0.05). Conclusions TEG sensitively identifies cirrhosis progression-related hypocoagulability and HBV-related hypercoagulability in PLC patients, providing valuable guidance for individualized perioperative coagulation management.