Splenectomy leads to a persistent hypercoagulable state after trauma.
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.
Watters
Jennifer M
JM
Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, OR, USA. wattersj@ohsu.edu
Sambasivan
Chitra N
CN
Zink
Karen
K
Kremenevskiy
Igor
I
Englehart
Michael S
MS
Underwood
Samantha J
SJ
Schreiber
Martin A
MA
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*