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

Soames Boyle, Richard H. White, Ann Brunson, Ted Wun

    Research output: Contribution to journalArticle

    89 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)4782-4790
    Number of pages9
    JournalBlood
    Volume121
    Issue number23
    DOIs
    StatePublished - Jun 6 2013

    Fingerprint

    Idiopathic Thrombocytopenic Purpura
    Venous Thromboembolism
    Splenectomy
    Sepsis
    Hazards
    Incidence
    Confidence Intervals
    Surgery
    Adrenal Cortex Hormones
    Embolism
    Venous Thrombosis
    Comorbidity
    Guidelines
    Recurrence
    Lung

    ASJC Scopus subject areas

    • Hematology
    • Biochemistry
    • Cell Biology
    • Immunology

    Cite this

    Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia. / Boyle, Soames; White, Richard H.; Brunson, Ann; Wun, Ted.

    In: Blood, Vol. 121, No. 23, 06.06.2013, p. 4782-4790.

    Research output: Contribution to journalArticle

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    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.",
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