Active or recent (≤6 months) variceal hemorrhage in HCC patient with cirrhosis. Mandates...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-HCC-VARICEAL-BLEED`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	Active or recent (≤6 months) variceal hemorrhage in HCC patient with cirrhosis. Mandates EGD assessment + variceal band ligation BEFORE any bevacizumab-containing regimen (atezo+bev, IMbrave150 prerequisite). Active bleeding is an absolute hold on systemic therapy until controlled.
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-HCC-SYSTEMIC-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "active_variceal_bleed",
      "value": true
    },
    {
      "finding": "recent_variceal_bleed_6mo",
      "value": true
    },
    {
      "finding": "untreated_high_risk_varices",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

IMbrave150 explicitly excluded patients with high-risk varices not treated by ligation/banding. Routes patient to durva+treme (STRIDE) alternative (HIMALAYA — no bev exposure) OR to TKI (sorafenib / lenvatinib) alone if anti-angiogenic risk also unacceptable.

Used By

Algorithms

ALGO-HCC-SYSTEMIC-1L - ALGO-HCC-SYSTEMIC-1L

Indications

IND-HCC-SYSTEMIC-1L-ATEZO-BEV - IND-HCC-SYSTEMIC-1L-ATEZO-BEV
IND-HCC-SYSTEMIC-2L-RAMUCIRUMAB - IND-HCC-SYSTEMIC-2L-RAMUCIRUMAB
IND-HCC-SYSTEMIC-2L-REGORAFENIB - IND-HCC-SYSTEMIC-2L-REGORAFENIB