Splenectomy leads to a persistent hypercoagulable state after trauma

• Published in: The American journal of surgery Vol. 199; no. 5; pp. 646 - 651
• Main Authors: Watters, Jennifer M., M.D, Sambasivan, Chitra N., M.D, Zink, Karen, M.D, Kremenevskiy, Igor, M.D., Ph.D, Englehart, Michael S., M.D, Underwood, Samantha J., M.S, Schreiber, Martin A., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2010; Elsevier Limited
• Subjects: Adult; Blood; Blood cells; Blood Chemical Analysis; Blood Coagulation Disorders - epidemiology; Blood Coagulation Disorders - etiology; Coagulation; Cohort Studies; Crosslinking; Female; Fibrin; Fibrinogen; Fibrinolysis; Follow-Up Studies; Group dynamics; Humans; Hypercoagulable; Incidence; Infections; Injury Severity Score; Laboratories; Male; Multiple Trauma - diagnosis; Multiple Trauma - mortality; Multiple Trauma - surgery; Patients; Platelet Count; Probability; Prospective Studies; Prothrombin Time; Reference Values; Risk Assessment; Spleen; Splenectomy; Splenectomy - adverse effects; Splenectomy - methods; Studies; Surgery; t-Plasminogen activator; Thromboelastography; Thromboembolism; Thrombophilia - epidemiology; Thrombophilia - etiology; Thromboplastin; Thrombosis; Thrombosis - epidemiology; Thrombosis - etiology; Trauma; Wounds and Injuries - diagnosis; Wounds and Injuries - surgery; Splenectomy; Thromboelastography; Thromboembolism; Trauma; Hypercoagulable
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.01.015

Abstract Background It was hypothesized that splenectomy following trauma results in hypercoagulability. Methods A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury. Results Patients with splenectomy (n = 30) and nonoperative management (n = 50) were enrolled. Splenectomy patients were older, had higher Injury Severity Scores, and had longer intensive care unit and hospital stays ( P < .05). Splenectomy patients had significantly increased white blood cell counts and platelet counts at baseline and follow-up ( P < .01). Fibrinogen was initially elevated in both groups and remained elevated in the splenectomy group ( P < .05). Tissue plasminogen activator, plasminogen activator inhibitor–1, and activated partial thromboplastin time were higher in splenectomy patients only at baseline ( P < .05). Baseline thromboelastography showed faster fibrin cross-linking and enhanced fibrinolysis following splenectomy ( P < .05). Only clot strength was greater at follow-up in the splenectomy group ( P < .01). Deep venous thrombosis developed in 7% of splenectomy patients and no control patients ( P = .03). Conclusions A significant difference in deep venous thrombosis formation was noted, and coagulation assays indicated persistent hypercoagulability following splenectomy for trauma.