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Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy

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Abstract

Background

Portal and/or splenic vein thrombosis (PSVT) is a potentially lethal complication of splenectomy for hematologic disease. Known risk factors for PSVT include malignancy and splenomegaly. While these patients are believed to be hypercoagulable, the specific mechanism is unclear. The aim of this study is to evaluate whether specific acquired prothrombotic risk factors contribute to the development of PSVT following laparoscopic splenectomy (LS).

Methods

Consecutive patients undergoing LS were prospectively studied between 2005 and 2013. Preoperatively, patients were screened for prothrombotic states and surveillance duplex ultrasonography was performed between 1 week and 1 month postoperatively to assess for PSVT. The association between baseline prothrombotic disorders and PSVT was explored using descriptive statistics.

Results

Sixty-eight patients were included in the analysis, and 17 (25 %) of these developed PSVT. There were no differences in patients with and without PSVT with respect to age, body mass index, gender or surgical time. Preoperative spleen size, as determined by diagnostic imaging, and intraoperative blood transfusion were associated with PSVT. Seven of 9 patients (78 %) with massive splenomegaly (>20 cm) developed PSVT compared with 4 of 13 patients (31 %) with moderate splenomegaly (15–20 cm) and 6 of 45 patients (13 %) without (p < 0.001). Abnormalities in baseline prothrombotic screening tests were common, with 52 patients (75 %) demonstrating at least one; however, none were associated with the development of PSVT.

Conclusion

In patients scheduled for LS, screening for prothrombotic states is not useful to identify patients at risk of development of PSVT. Preoperative spleen size and blood transfusion were predictive of PSVT formation.

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Abbreviations

CT:

Computed tomography

INR:

International normalized ratio

LS:

Laparoscopic splenectomy

MTHFR:

Methylene tetrahydrofolate reductase

PAI-1:

Plasminogen activator inhibitor-1

PSVT:

Portal and/or splenic venous thrombosis

PTT:

Activated partial thromboplastin time

US:

Ultrasound

VTE:

Venous thromboembolism

vWF:

von Willebrand factor

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Acknowledgments

The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Covidien. Dr Feldman receives research and fellowship funding from Covidien and research support from Ethicon.

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Authors and Affiliations

  1. Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, L9-300, Montreal, QC, H3G 1A4, Canada

    Namdar Manouchehri, Pepa Kaneva & Liane S. Feldman

  2. Department of Medicine, Division of Hematology, McGill University Health Centre, Montreal, QC, Canada

    Chantal Séguin

  3. Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada

    Giovanni P. Artho

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  1. Namdar Manouchehri
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  2. Pepa Kaneva
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  5. Liane S. Feldman
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Correspondence to Liane S. Feldman.

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Drs. Manouchehri, Kaneva, Séguin and Artho have no conflicts of interest or financial ties to disclose.

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Manouchehri, N., Kaneva, P., Séguin, C. et al. Screening for thrombophilia does not identify patients at risk of portal or splenic vein thrombosis following laparoscopic splenectomy. Surg Endosc 30, 2119–2126 (2016). https://doi.org/10.1007/s00464-015-4476-3

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  • DOI: https://doi.org/10.1007/s00464-015-4476-3

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