Antithrombotic therapy for hepatic artery thrombosis following liver transplantation: a case report and literature review.

BACKGROUND: Hepatic artery thrombosis (HAT) is one of the most severe complications following liver transplantation (LT). Its prevention requires balancing the risks of bleeding and embolism. Due to the incomplete recovery of the coagulation and fibrinolytic system function in LT patients and considerable individual variability, there is currently no standardized protocol for HAT prevention. CASE PRESENTATION: This report presents a case of HAT in a patient with liver failure following LT. Following surgical thrombectomy and hepatic artery resection and anastomosis, the patient received combined antiplatelet and parenteral anticoagulant therapy during hospitalization. At discharge, sequential therapy was transitioned to direct oral anticoagulants (DOACs) for long-term prevention of HAT recurrence, resulting in favorable outcomes. This study also reviews relevant studies on HAT following LT and summarizes the current evidence-based treatment and antithrombotic prophylaxis strategies for HAT. CONCLUSION: Antithrombotic strategies vary according to the center. Although antiplatelet therapy has the highest level of evidence for HAT prevention, recent clinical experience also suggests a role for anticoagulants in selected patient populations. Regimen selection requires balancing thrombotic and hemorrhagic risks. In this case, we found that novel biomarkers (e.g., thrombin-antithrombin and plasmin-α2-plasmin inhibitor complexes) may guide anticoagulation decisions, and DOACs represent a promising long-term option for HAT prevention.