title: Systemic thromboembolic complications after laparoscopic splenectomy for idiopathic thrombocytopenic purpura in comparison to open surgery in the absence of anticoagulant prophylaxis.
abstract: BACKGROUND
  Idiopathic thrombocytopenic purpura (ITP) in adults has a chronic course and may necessitate splenectomy. The current study was undertaken to study the systemic thromboembolic complications of laparoscopic splenectomy (LS) versus open splenectomy (OS) in patients with ITP at two large referral hospitals.
  
  
  METHODS
  We conducted a retrospective analysis of 49 patients who underwent splenectomy (21 LS and 28 OS) for primary/relapsing refractory ITP between June 1995 and November 2004. Clinically and/or radiologically confirmed deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were assessed within 2 weeks before and after splenectomy. None had prophylactic anticoagulants immediately after surgery. Follow up of those who developed complications continued for at least 2 additional years to assess for contributing factors that may have been masked at the time of occurrence.
  
  
  RESULTS
  Two (9.5%) LS group had acute PE within 5 days of LS and their platelet count reached 500A103/I(1/4)L within 4 days and 1000A103/I(1/4)L within 7 days after surgery. Three conversions to OS occurred; none had VTE. DVT occurred in 3 patients (10.7%) in the OS group; none were life threatening. There were no deaths.
  
  
  CONCLUSIONS
  Life-threatening venous thromboembolic events are serious complications after LS and OS for ITP patients if prophylactic anticoagulants are not administered. Patients at risk are those who both have an exponential rise of the platelet count, although factors other than the platelet count may be contributing in OS. Postsplenectomy, ITP should be considered as a thrombophilic condition and studies of additional measures to prevent such events are warranted.
authors.affiliation: Adult Hematology-Oncology-Transplant Division, Shams University Hospitals, Cairo, Egypt. saidyousuf@yahoo.com
authors.forename: Said Yousuf
authors.initials: SY
authors.lastname: Mohamed
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abdel-Nabi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Inam
authors.forename: Mohammad
authors.initials: M
authors.lastname: Bakr
authors.forename: Khaled
authors.initials: K
authors.lastname: El Tayeb
authors.forename: Abu Jafar M
authors.initials: AJ
authors.lastname: Saleh
authors.forename: Hazaa
authors.initials: H
authors.lastname: Alzahrani
authors.forename: Said H
authors.initials: SH
authors.lastname: Abdu
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants