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Splanchnic Vein Thrombosis in Liver Cirrhosis After Splenectomy or Splenic Artery Embolization: A Systematic Review and Meta-Analysis

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Abstract

Introduction

Splenectomy and splenic artery embolization are major treatment options for hypersplenism and portal hypertension in liver cirrhosis, but may lead to splanchnic vein thrombosis (SVT), which is potentially lethal. We conducted a systematic review and meta-analysis to explore the incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization and the risk factors for SVT.

Methods

All relevant studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The incidence of SVT in liver cirrhosis after splenectomy or splenic artery embolization was pooled. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results

Sixty-six studies with 5632 patients with cirrhosis were included. The pooled incidence of SVT after splenectomy and splenic artery embolization was 24.6% (95% CI 20.2–29.3%) and 11.7% (95% CI 7.1–17.3%), respectively. A meta-analysis of three comparative studies demonstrated that the incidence of SVT after splenectomy was statistically similar to that after splenic artery embolization (OR 3.15, P = 0.290). Platelet count, mean platelet volume, preoperative splenic or portal vein diameter, preoperative or postoperative portal blood velocity, splenic volume and weight, and periesophagogastric devascularization were significant risk factors for SVT after splenectomy. Postoperative use of preventive antithrombotic therapy was a significant protective factor against SVT after splenectomy.

Conclusions

SVT is common in liver cirrhosis after splenectomy and splenic artery embolization. Coagulation and hemostasis factors, anatomical factors, and surgery-related factors have been widely identified for the assessment of high risk of SVT after splenectomy. Prophylactic strategy after splenectomy, such as antithrombotic therapy, might be considered in such high-risk patients.

Study Registration

This study was registered in PROSPERO with a registration number of CRD42019129673.

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Acknowledgements

Funding

The study was partially supported by the Science and Technology Project Foundation of Shenyang (19-112-4-005). No Rapid Service Fee was received by the journal for the publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Authorship Contributions

All authors made substantial contributions to the intellectual content of this paper. YW: methodology; formal analysis; investigation; writing–original draft; writing–review and editing. HL: validation; writing–original draft; writing–review and editing. TZ: formal analysis; writing–review and editing. ZB: data curation; writing–review and editing. XX: formal analysis; validation; writing–review and editing. GBLS: writing–review and editing. LW: data curation. XQ, conceptualization; methodology; validation; investigation; writing–original draft; writing–review and editing; supervision; project administration.

Prior Publication

This work was partially presented as a poster presentation at the Asian-Pacific Association for the Study of Liver (APASL) 2020 Conference held in Bali, Indonesia from March 4, 2020 to March 8, 2020. Please see the following link https://link.springer.com/content/pdf/10.1007/s12072-020-10030-4.pdf.

Disclosures

Yanyan Wu, Hongyu Li, Tiansong Zhang, Zhaohui Bai, Xiangbo Xu, Giovanni Battista Levi Sandri, Le Wang, and Xingshun Qi have nothing to disclose.

Compliance with Ethics Guidelines

This is a meta-analysis based on previously published studies and does not involve any new studies of human or animal subjects performed by any of the authors. The work is conducted according to MOOSE and PRISMA. The MOOSE and PRISMA checklists are shown in the supplementary material.

Author information

Author notes

  1. Yanyan Wu, Hongyu Li, and Tiansong Zhang contributed equally to this work.

Authors and Affiliations

  1. Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, People’s Republic of China

    Yanyan Wu, Hongyu Li, Zhaohui Bai, Xiangbo Xu, Le Wang & Xingshun Qi

  2. Postgraduate College, Jinzhou Medical University, Jinzhou, People’s Republic of China

    Yanyan Wu

  3. Department of Traditional Chinese Medicine, Jing’an District Central Hospital, Shanghai, China

    Tiansong Zhang

  4. Postgraduate College, Shenyang Pharmaceutical University, Shenyang, People’s Republic of China

    Zhaohui Bai & Xiangbo Xu

  5. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy

    Giovanni Battista Levi Sandri

  6. Postgraduate College, Dalian Medical University, Dalian, People’s Republic of China

    Le Wang

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  1. Yanyan Wu
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Correspondence to Xingshun Qi.

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Wu, Y., Li, H., Zhang, T. et al. Splanchnic Vein Thrombosis in Liver Cirrhosis After Splenectomy or Splenic Artery Embolization: A Systematic Review and Meta-Analysis. Adv Ther 38, 1904–1930 (2021). https://doi.org/10.1007/s12325-021-01652-7

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  • DOI: https://doi.org/10.1007/s12325-021-01652-7

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