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Thromboembolic Events Following Splenectomy: Risk Factors, Prevention, Management and Outcomes

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Abstract

Background

Thromboembolic events following splenectomy are not uncommon. However, the role of thromboprophylaxis and risk factors for thrombosis, as well as the clinical course and outcomes, are not well characterized.

Methods

A retrospective review of individuals who underwent splenectomy between January 2006 and December 2015 in two university hospitals.

Results

Overall, 297 patients underwent splenectomy [open splenectomy (n = 199), laparoscopic splenectomy (n = 98)]. Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 h after surgery until discharge) was provided for all patients. One hundred and sixteen patients (39%) also received an extended thromboprophylaxis course of enoxaparin for 2–4 weeks after discharge. Twenty-three patients (7.7%) experienced thrombotic complications following splenectomy, including 16 cases (5.4%) of portal-splenic mesenteric venous thrombosis (PSMVT), 5 (1.7%) pulmonary embolism and 2 (0.7%) deep vein thrombosis. Longer operative time (mean operative time of 405 vs. 273 min, P = 0.03) was independently associated with PSMVT. Post-splenectomy thrombocytosis was not associated with thrombosis (P = 0.41). The overall thrombosis rate was significantly lower in patients who received an extended thromboprophylaxis course following splenectomy (3.4 vs. 10.5%, P = 0.02). Complete resolution of thrombosis was observed in most cases (n = 20, 87.0%), with no recurrent thrombosis during a mean follow-up of 38 ± 25 months.

Conclusions

Thromboembolic complications, mainly PSMVT, are common following splenectomy. Longer operative time was associated with thrombosis. Significantly lower rates of thrombosis were found in patients who received an extended thromboprophylaxis course.

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References

  1. Ikeda M, Sekimoto M, Takiguchi S et al (2007) Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment. Am J Surg 193:21–25

    Article  PubMed  Google Scholar 

  2. Lee DH, Barmparas G, Fierro N et al (2015) Splenectomy is associated with a higher risk for venous thromboembolism: a prospective cohort study. Int J Surg 24:27–32

    Article  PubMed  Google Scholar 

  3. Kristinsson SY, Gridley G, Hoover RN et al (2014) Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 99:392–398

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chaffanjon PC, Brichon PY, Ranchoup Y et al (1998) Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler colour flow imaging. World J Surg 22:1082–1086. doi:10.1007/s002689900521

    Article  CAS  PubMed  Google Scholar 

  5. Griesshammer M, Bangerter M, Sauer T et al (1999) Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count. J Intern Med 245:295–300

    Article  CAS  PubMed  Google Scholar 

  6. Habermalz B, Sauerland S, Decker G et al (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 22(4):821–848

    Article  CAS  PubMed  Google Scholar 

  7. Tincani E, Piccoli M, Turrini F et al (2005) Video laparoscopic surgery: is out-of-hospital thromboprophylaxis necessary? J Thromb Haemost 3(2):216–220

    Article  CAS  PubMed  Google Scholar 

  8. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  9. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  10. Krauth MT, Lechner K, Neugebauer EAM et al (2008) The postoperative splenic/portal vein thrombosis after splenectomy and its prevention—an unresolved issue. Haematologica 93:1227–1232

    Article  PubMed  Google Scholar 

  11. van’t Riet M, Burger JW, van Muiswinkel JM et al (2000) Diagnosis and treatment of portal vein thrombosis following splenectomy. Br J Surg 87:1229–1233

    Article  PubMed  Google Scholar 

  12. Manouchehri N, Kaneva P, Séguin C et al (2016) Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy. Surg Endosc 30:2119–2126

    Article  PubMed  Google Scholar 

  13. Pietrabissa A, Moretto C, Antonelli G et al (2004) Thrombosis in the portal venous system after elective laparoscopic splenectomy. Surg Endosc 18(7):1140–1143

    Article  CAS  PubMed  Google Scholar 

  14. Campbell PJ, MacLean C, Beer PA et al (2012) Correlation of blood counts with vascular complications in essential thrombocythemia: analysis of the prospective PT1 cohort. Blood 120:1409–1411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Budde BU, Scharf RE, Franke P et al (1993) Elevated platelet count as a cause of abnormal von Willebrand factor multimer distribution in plasma. Blood 82:1749–1758

    CAS  PubMed  Google Scholar 

  16. Guyatt GH, Akl EA, Crowther M et al (2012) Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:7S–47S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Ms. Cindy Cohen for her editorial assistance.

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Authors and Affiliations

  1. Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel

    Amihai Rottenstreich & Yosef Kalish

  2. Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel

    Geffen Kleinstern

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Geffen Kleinstern

  4. Institute of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel

    Galia Spectre & Esther Ziv

  5. The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Galia Spectre

  6. Internal Medicine D, Hematology Unit, Sha’are Zedek Medical Center, Jerusalem, Israel

    Nael Da’as

Authors
  1. Amihai Rottenstreich
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  2. Geffen Kleinstern
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  3. Galia Spectre
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  4. Nael Da’as
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  5. Esther Ziv
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  6. Yosef Kalish
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Contributions

AR, GS and YK reviewed the literature and wrote the paper. YK, ND and GS treated the patients and collected the data. EZ and GK collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yosef Kalish.

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Conflict of interest

Drs. Rottenstriech, Kleinstern, Spectre, Da’as, Ziv and Kalish have no conflicts of interest or financial ties to disclose.

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Rottenstreich, A., Kleinstern, G., Spectre, G. et al. Thromboembolic Events Following Splenectomy: Risk Factors, Prevention, Management and Outcomes. World J Surg 42, 675–681 (2018). https://doi.org/10.1007/s00268-017-4185-2

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  • DOI: https://doi.org/10.1007/s00268-017-4185-2

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