title: Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia.
abstract: 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 postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (<90 days; hazard ratio [HR] 5.4 [confidence interval (CI), 2.3-12.5]), but not late (≥90 days; HR 1.5 [CI, 0.9-2.6]) after splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the 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 (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis.
authors: Division of Hematology Oncology, Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA.
authors: Soames
authors: S
authors: Boyle
authors: Richard H
authors: RH
authors: White
authors: Ann
authors: A
authors: Brunson
authors: Ted
authors: T
authors: Wun
mesh_terms: D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D013156:Splenectomy / Q000009:adverse effects*; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality
references: Circulation. 2003 Jun 17;107(23 Suppl 1):I4-8
references: 12814979
references: Blood. 2011 Apr 21;117(16):4190-207
references: 21325604
references: Surg Endosc. 2004 Aug;18(8):1283-7
references: 15457387
references: Int J Hematol. 2010 Sep;92(2):289-95
references: 20652840
references: Br J Haematol. 2011 Feb;152(3):360-2
references: 20955411
references: Br J Haematol. 2006 May;133(4):364-74
references: 16643442
references: Ann Hematol. 2002 Jun;81(6):312-9
references: 12107560
references: Scand J Infect Dis. 2000;32(5):521-5
references: 11055658
references: Am Surg. 2003 Nov;69(11):951-6
references: 14627254
references: Blood. 2009 Mar 5;113(10):2161-71
references: 18981291
references: Eur J Haematol. 1999 Apr;62(4):219-22
references: 10227454
references: Blood. 2001 May 1;97(9):2549-54
references: 11313240
references: Blood. 2004 Nov 1;104(9):2623-34
references: 15217831
references: Tex Med. 1982 Aug;78(8):47-9
references: 6890242
references: Platelets. 2011;22(1):1-7
references: 20964585
references: J Laparoendosc Adv Surg Tech A. 2013 Feb;23(2):123-8
references: 23331183
references: Thromb Haemost. 2010 Nov;104(5):919-30
references: 20941466
references: Am J Med. 1980 Sep;69(3):430-42
references: 6998293
references: Ann Intern Med. 2009 Oct 20;151(8):546-55
references: 19841456
references: Br J Haematol. 2012 Jul;158(1):16-29
references: 22571181
references: Am J Hematol. 2004 Jul;76(3):205-13
references: 15224353
references: Blood. 2009 Oct 1;114(14):2861-8
references: 19636061
references: N Engl J Med. 2003 Aug 28;349(9):831-6
references: 12944568
references: Blood. 2009 Mar 12;113(11):2386-93
references: 19005182
references: Br J Surg. 2000 Sep;87(9):1229-33
references: 10971433
references: J Infect. 2001 Oct;43(3):182-6
references: 11798256
references: Surg Laparosc Endosc Percutan Tech. 2002 Dec;12(6):412-9
references: 12496547
references: Br J Haematol. 2003 Sep;122(6):966-74
references: 12956768
references: Arch Intern Med. 2006 Feb 27;166(4):458-64
references: 16505267
references: Blood. 2011 Mar 31;117(13):3514-20
references: 21263148
references: Ann Hematol. 2004 Dec;83(12):764-8
references: 15309522
references: Eur J Intern Med. 2010 Feb;21(1):12-6
references: 20122606
references: J Thromb Haemost. 2010 Jun;8(6):1413-6
references: 20218983
references: Blood. 2007 Feb 15;109(4):1401-7
references: 17077333
references: Thromb Res. 2010 Jul;126(1):61-7
references: 20430419
references: J Gastrointest Surg. 2008 Nov;12(11):2015-22
references: 18668299
references: Am J Med. 1995 May;98(5):436-42
references: 7733121
references: Haematologica. 2013 Jun;98(6):875-80
references: 23144195
references: Surg Endosc. 2006 Aug;20(8):1208-13
references: 16865623
references: Haematologica. 2001 May;86(5):504-9
references: 11410414
references: Science. 2009 Jul 31;325(5940):612-6
references: 19644120
references: Med Care. 1998 Jan;36(1):8-27
references: 9431328
references: Haematologica. 2005 Jan;90(1):72-7
references: 15642672
references: Blood. 2004 Aug 15;104(4):956-60
references: 15100149