New article re: splenectomy and associated risks

Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the post-splenectomy state. To better define these risks, we identified a cohort of 9,976 patients with ITP, 1,762 of whom underwent splenectomy.

The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared to 1% in patients who did not undergo splenectomy; and venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared to 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (< 90 days), but not late (≥ 90 days) after splenectomy. There was increased risk of VTE both early and late after splenectomy. The cumulative incidence of sepsis was 11.1% amongst ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis both early and late, depending on co-morbidities). We conclude that ITP patients post-splenectomy are at increased risk for AbVTE, VTE, and sepsis.



bloodjournal.hematologylibrary.org/content/early/2013/05/01/blood-2012-12-467068.abstract?ct&ct=b3b42658e7bc215a4e4481274dec71ad6a749eed5ddacb364dfa278f2c496e51aa6ad002b596728cd62ec76ad0ef663ef827c50a4af6619b020df8dc6deb1756