title: Thrombocytosis in splenic trauma: In-hospital course and association with venous thromboembolism.
abstract: BACKGROUND
  Thrombocytosis is common following elective splenectomy and major trauma. However, little is known about the in-hospital course of platelet count (PC) and incidence of thrombocytosis after splenic trauma. Extreme thrombocytosis (PC>1000×109) is associated with increased risk of venous thromboembolism (VTE) in primary thrombocytosis leading to the use of acetylsalicylic acid (ASA) for risk reduction, but the need for this agent in splenic trauma is undefined.
  
  
  METHODS
  Retrospective cohort study of all patients with splenic trauma between April 1, 2010 and March 31, 2014. The in-hospital course of PC was assessed based on splenic injury management type. The association of management type with thrombocytosis was evaluated using a multivariable logistic regression model adjusting for potential confounders. The association of thrombocytosis, extreme thrombocytosis, and ASA use for the outcome of VTE was explored.
  
  
  RESULTS
  156 patients were eligible, PC initially increased in all patients with the highest peak after total splenectomy. The incidence of thrombocytosis was 41.0% (64/156). Thrombocytosis was more likely following splenectomy compared with spleen preserving strategies independent of length of stay, injury grade, ISS, age and transfusion (OR 7.58, 95% CI: 2.26-25.45). Splenectomy was associated with extreme thrombocytosis (OR 10.39, 95% CI: 3.59-30.07).
  
  
  CONCLUSIONS
  Thrombocytosis in splenic trauma is more likely after splenectomy than with spleen preserving strategies. Splenectomy is associated with extreme thrombocytosis. There was insufficient data in our study to determine the use of ASA as primary prevention of VTE after splenic trauma.
authors.affiliation: Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.
authors.forename: Tze L
authors.initials: TL
authors.lastname: Chia
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Chesney
authors.affiliation: Division of General Surgery, St. Michael's Hospital, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Isa
authors.affiliation: Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.
authors.forename: Gevork
authors.initials: G
authors.lastname: Mnatzakanian
authors.affiliation: Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.
authors.forename: Errol
authors.initials: E
authors.lastname: Colak
authors.affiliation: Federal University of Juiz de Fora, Juiz de Fora, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Belmont
authors.affiliation: Institute of Health Policy, Management and Education, University of Toronto, Toronto, Canada.
authors.forename: Dhruvin
authors.initials: D
authors.lastname: Hirpara
authors.affiliation: Institute of Medical Science, University of Toronto, Toronto, Canada.
authors.forename: Precilla V
authors.initials: PV
authors.lastname: Veigas
authors.affiliation: Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Acuna
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: rezendenetoj@smh.ca.
authors.forename: Joao
authors.initials: J
authors.lastname: Rezende-Neto
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D000328:Adult; D002170:Canada; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D013922:Thrombocytosis / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control
keywords: Acetylsalicylic acid; Embolization; Non-operative management; Platelets; Splenectomy; Splenic injury; Thrombocytosis; Trauma; Venous thromboembolism