title: Splenectomy leads to a persistent hypercoagulable state after trauma.
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.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, OR, USA. wattersj@ohsu.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Watters
authors.forename: Chitra N
authors.initials: CN
authors.lastname: Sambasivan
authors.forename: Karen
authors.initials: K
authors.lastname: Zink
authors.forename: Igor
authors.initials: I
authors.lastname: Kremenevskiy
authors.forename: Michael S
authors.initials: MS
authors.lastname: Englehart
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Underwood
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D001778:Blood Coagulation Disorders / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010976:Platelet Count; D011336:Probability; D011446:Prospective Studies; D011517:Prothrombin Time; D012016:Reference Values; D018570:Risk Assessment; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D019851:Thrombophilia / Q000453:epidemiology* / Q000209:etiology; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery*