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

• Published in: World journal of surgery Vol. 42; no. 3; pp. 675 - 681
• Main Authors: Rottenstreich, Amihai, Kleinstern, Geffen, Spectre, Galia, Da’as, Nael, Ziv, Esther, Kalish, Yosef
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Complications; Compression; Embolism; General Surgery; Health risk assessment; Hosiery; Laparoscopy; Medicine; Medicine & Public Health; Original Scientific Report; Patients; Pharmacology; Risk analysis; Risk factors; Risk management; Spleen; Splenectomy; Surgery; Thigh; Thoracic Surgery; Thrombocytosis; Thromboembolism; Thrombosis; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4185-2

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.