What Are the Main Risk Factors for Venous Thrombosis After Splenectomy?

Patients with splenomegaly and myeloproliferative disorders had an increased risk for porto-spleno-mesenteric venous thrombosis (PSM VT), according to a retrospective cohort study published in Frontiers in Immunology.

Elective splenectomy is a primary treatment for many hematological diseases; however, PSM VT is a major postoperative complication. Researchers sought to identify risk factors for this complication and describe outcomes of subsequent treatments.

Lead author, Ludovica Baldari, MD, of the Policlinico of Milan in Italy, noted that “the incidence of porto-spleno-mesenteric venous thrombosis after splenectomy seems to be higher than previously thought and reported… screening through doppler ultrasound performed 10 days after surgery allows detection of the great majority of thrombosis.”

PSM VT Incidence Appears Higher than Previously Described

The study included 22 patients who underwent elective splenectomy from April 2017 to January 2023 at the authors’ center. All participants had undergone doppler ultrasound screening for venous thrombosis. The investigators reviewed demographic and operation data for associations with postoperative PSM VT.

The cohort had 10 female and 12 male patients, and their underlying malignancies were immune thrombocytopenia (n=6), myeloproliferative disorder (n=6), hereditary spherocytosis (n=4), thalassemia (n=1), lymphoma (n=1), leukemia (n=3), and other malignancies (n=3).

Of the 22 patients, six developed PSM VT after splenectomy, though only two were symptomatic. All six cases were treated with anticoagulation therapy and were completely resolved. The researchers identified four risk factors associated with PSM VT development: spleen diameter (P=.03), myeloproliferative disorder (P=.02), intraoperative platelet transfusion (P=.002), and intraoperative red blood cells transfusions (P=.009).

While Dr. Baldari and colleagues acknowledged their analysis was limited by a small sample size and some data gaps in the retrospective cohort, they nonetheless concluded that, “according to our results, splenomegaly and myeloproliferative disorders are significantly associated with increased risk of PSM VT.”

Reference

Baldari L, Boni L, Giuliani B, et al. Porto-spleno-mesenteric venous thrombosis after elective splenectomy: a retrospective cohort study. Front Immunol. 2023;14:1216283. (2023); doi:10.3389/fimmu.2023.1216283

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