Blood Journal
Leading the way in experimental and clinical research in hematology

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

  1. Soames Boyle1,
  2. Richard H. White2,
  3. Ann Brunson1, and
  4. Ted Wun1,*
  1. 1 Division of Hematology Oncology, Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, United States;
  2. 2 Division of General Internal Medicine, Department of Internal Medicine, UC Davis School of Medicine, Sacramento, CA, United States
  1. * Corresponding author; email: ted.wun{at}ucdmc.ucdavis.edu

Key points

  • After splenectomy patients with ITP have higher risk of venous thrombosis and sepsis than patients with ITP who do not undergo splenectomy

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 post-splenectomy state. To better define these risks, we identified a cohort of 9,976 patients with ITP, 1,762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared to 1% in patients who did not undergo splenectomy; and venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared to 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (< 90 days) [HR 5.4 (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% amongst 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 co-morbidities). We conclude that ITP patients post-splenectomy are at increased risk for AbVTE, VTE, and sepsis.

  • Submitted December 5, 2012.
  • Accepted April 16, 2013.