Introduction: Hepatocellular carcinoma (HCC) is frequently associated with portal vein thrombosis (PVT) with prevalence ranging from 25% to 50%. PVT is associated with poor prognosis, limiting the available therapeutic options for these patients. Our objective was to determine the prevalence and risk factors for PVT in patients with HCC.

Method: A retrospective analysis was performed on the prospectively collected data from January 2018 to March 2020. All patients with HCC discussed in our weekly multidisciplinary liver clinic were reviewed. Multivariate analysis was done to identify the independent risk factors for PVT in HCC patients. A p-value of <0.05 was considered significant.

Result: Of 316 patients, the prevalence of PVT was 31% (n = 98). Larger tumour size (p < 0.001), raised Alpha Fetoprotein (AFP) level (p = 0.036) and higher Child–Pugh class (p = 0.008) were significantly associated with PVT. In 216 patients with preserved liver function (Child–Pugh class A), PVT was seen in 53 (24.5%) patients. Large tumour size (p < 0.001) and higher AFP levels (p = 0.021) were independent risk factors.

Conclusion: Overall prevalence of PVT in HCC was 31% whereas 24.5% in patients with early cirrhosis (Child–Pugh class A). We identified various risk factors associated with PVT in our local population, highlighting the importance of early and regular screening of cirrhotic patients including Child–Pugh class A.