Post Splenectomy portal vien thrombosis

Has any one developed clotting issues post splenectomy requiring blood thinners?

The reason I ask this is my Daughter had her splene removed last May. One week later she developed a massive portal vien clott requiring an emergency TIPS procedure. After getting this under control she need blood thinners believe it or not.
Since then she started promacta and it was working well. But the clotting issues presisted. These begin with extreme abdominal pain. The first episode was around the kidneys, three months later was around the galbladder. Both were able to be brought under control with meds.
April 10 she began again with extreme abdominal pain. This time it was her lower intestines. After three weeks in the hospital attempting to correct with meds, she developed a perferation in her lower bowel requiring an emergency bowl resection.
By the way the splenectomy was a complete failure. She was still killing platelets as fast as she could make them. Thank God for the promacta.
Now here's the tough part. After the bowel resection, she could not injest her promacta so her platelets have been between 3000 to 7000. They started Nplate in hopes it would pick up where the promacta left off, but so far nothing.
She's 5 days post surgery and just now beginning to show some bowel sounds. Daily transfusions taking her from 3000 to 20,000. Our hope is her intestines begin working soon so she can begin taking the promacta again. Now her daily routine will also include an injection of arixtra. A blood thinner that also has a strong anti-inflamitory effect.
Sorry for the spelling, but I think you all get the idea.

So sorry to hear all of that! Poor girl!

Clotting issues have been reported with both ITP and splenectomy. Unfortunately, that is one thing that can come along with either or both of those. With ITP, some people have APS (Antiphospholipid Syndrome) which can cause clotting. A few have had to be on blood thinners while having ITP. I have the antibodies, but have never had a clot. Right now, I just take aspirin. People with ITP are also known to have microplatelet particles, which are tiny platelet fragments that cannot be counted. Those can also contribute to clotting. Has she been tested for APS? I read an article once that stated that it's possible the body lowers platelets on purpose to protect against clotting if the APS antibodies are present (see below).

Both APS and microplatelet particles can increase the clotting risk after splenectomy. It can be a tough thing to balance. I hope she levels out soon with a good treatment plan.


Article:

Eleven ITP patients in our study experienced thrombosis (6 patients had venous thromboembolism and 5 had arterial thrombosis). We noticed that thrombotic complications mostly developed after the platelet counts had exceeded 100 × 109/L after methylprednisolone therapy or splenectomy in ITP patients with persistent APA positivity. These data are consistent with the suggestion that severe thrombocytopenia might be a protective factor for the development of thrombosis in APS. Prospective studies are needed to determine whether low-dose aspirin or other drugs have a prophylactic effect on thrombosis in these patients.

In conclusion, we propose that measurement of APAs, especially LA, in patients with an initial diagnosis of ITP may identify a subgroup of patients with a high risk of developing APS features (ie, thrombosis or fetal loss). The episodic nature of the clinical complications of APS, compared with the gradual development of other autoimmune diseases such as SLE, warrants a need for a serologic workup rather than clinical follow-up. A prophylactic drug regimen may avoid the potential complications of APS in patients with ITP and positive LA, considering the high correlation between LA positivity and thrombosis. Future research may determine other markers, including genetic factors, that may help to identify high-risk patients.


www.bloodjournal.org/cgi/content/full/98/6/1760

Thanks Sandi, I'll pass that along. Yes the balancing of the platelet therpy and blood thinner need is a difficult thing to achieve. We've found that Cumaden was very tough to balance, in fact we believe that might just be the culprit for this recent episode. She was at 1.6 when she was addmitted. They said they wanted her to be at 2.0 to 2.5. But trying to balance both the promacta and cumaden is hard. That being said, she will now be on arixtra. A once daily injection. Nice thing about the arixtra is that it also has a strong anti inflamitory effect. Inflamation due to clotting seems to proceed these episodes. So arixtra it is. Now if we can get her gut working again so she can get back on the promactra and get her numbers back up.