Background <p>Hepatocellular carcinoma (HCC) is a major global health concern, associated with substantial morbidity and mortality. Thrombosis, including venous thromboembolism, deep vein thrombosis, and portal vein thrombosis, further exacerbates the clinical burden in liver cancer patients. However, the incidence rate thrombosis in this population remains incompletely estimated. The main aim of systematic review and meta-analysis is estimating the incidence of thrombotic events in patients with liver cancer.</p> Methods <p>We conducted a comprehensive search of databases, including PubMed, Scopus, Web of Science, and Embase, for studies (from inception to January 30, 2025) reporting thrombotic events in liver cancer patients. Pooled estimates of thrombosis incidence were calculated using random effect models, and subgroup analyses were performed based on the follow-up periods and presence of cirrhosis with HCC versus HCC alone.</p> Results <p>A total of 24 studies comprising 935,639 liver cancer patients were included in the analysis. The pooled incidence of thrombotic events in liver cancer patients was 35.85 per 1,000 patients (95% CI: 24.49–52.47). The incidence rate varied by follow-up period, with rates of 28.99 (95% CI: 11.34–74.4), 21.16 (95% CI: 9.96–44.93), and 47.19 (95% CI: 22.16–98.19) for 6-month, 12-month, and &gt; 12-month follow-ups, respectively. The incidence in patients with cirrhosis and HCC was higher than those with HCC alone: 229.56 per 1,000 patients (95% CI: 166.40–316.69) versus 26.61 per 10,000 patients (95% CI: 18.71–37.84), respectively.</p> Conclusion <p>Patients with HCC are at significant increased risk of thrombosis. This meta-analysis highlights the importance of monitoring thrombotic risk in liver cancer management. Future research should focus on targeted prevention and treatment strategies to reduce thromboembolic complications in this high-risk population.</p> Graphical abstract <p></p>