Abstract
Introduction: The impact of splenectomy on venous thrombosis (VTE), abdominal thrombosis (abVTE) and sepsis in autoimmune hemolytic anemia (AIHA) is unclear. Methods: Using the California Discharge Dataset 1991–2014, 4756 AIHA patients were identified. Cumulative incidences (CI) of VTE, abVTE, and sepsis were determined in patients with and without splenectomy. Using propensity score matching adjusted for competing risk of death, the association between VTE, abVTE and sepsis with splenectomy was determined. Results: In those without splenectomy, the CIs of VTE, abVTE, and sepsis were 1.4%, 0.2%, and 4.3% respectively, compared to 4.4%, 3.0% and 6.7% with splenectomy. Splenectomy was associated with increased risk for VTE in immediate (HR 2.66, CI 1.36–5.23) and late (HR 3.29, CI 2.10–5.16) post-operative periods. AbVTE was increased in immediate post-operative period (HR 34.11, CI 4.93–236.11). Sepsis was only increased in late post-operative period (HR 2.20, CI 1.75–2.77). In multivariate models, older age, having >1 comorbidity and having VTE, abVTE, and sepsis were associated with increased mortality. Splenectomy was not associated with increased mortality. Discussion: Splenectomy in AIHA was associated with significant early thrombotic risk and long-term morbidity. Future research should evaluate the role of splenectomy in AIHA patients, and potential long-term thrombotic and antibiotic prophylaxis.
| Original language | English (US) |
|---|---|
| Article number | 102388 |
| Journal | Blood Cells, Molecules, and Diseases |
| Volume | 81 |
| DOIs | |
| State | Published - Mar 2020 |
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Keywords
- Autoimmune hemolytic anemia
- Sepsis
- Splenectomy
- Thrombosis
ASJC Scopus subject areas
- Molecular Medicine
- Molecular Biology
- Hematology
- Cell Biology
Cite this
Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia. / Ho, Gwendolyn; Brunson, Ann; Keegan, Theresa H.M.; Wun, Ted.
In: Blood Cells, Molecules, and Diseases, Vol. 81, 102388, 03.2020.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia
AU - Ho, Gwendolyn
AU - Brunson, Ann
AU - Keegan, Theresa H.M.
AU - Wun, Ted
PY - 2020/3
Y1 - 2020/3
N2 - Introduction: The impact of splenectomy on venous thrombosis (VTE), abdominal thrombosis (abVTE) and sepsis in autoimmune hemolytic anemia (AIHA) is unclear. Methods: Using the California Discharge Dataset 1991–2014, 4756 AIHA patients were identified. Cumulative incidences (CI) of VTE, abVTE, and sepsis were determined in patients with and without splenectomy. Using propensity score matching adjusted for competing risk of death, the association between VTE, abVTE and sepsis with splenectomy was determined. Results: In those without splenectomy, the CIs of VTE, abVTE, and sepsis were 1.4%, 0.2%, and 4.3% respectively, compared to 4.4%, 3.0% and 6.7% with splenectomy. Splenectomy was associated with increased risk for VTE in immediate (HR 2.66, CI 1.36–5.23) and late (HR 3.29, CI 2.10–5.16) post-operative periods. AbVTE was increased in immediate post-operative period (HR 34.11, CI 4.93–236.11). Sepsis was only increased in late post-operative period (HR 2.20, CI 1.75–2.77). In multivariate models, older age, having >1 comorbidity and having VTE, abVTE, and sepsis were associated with increased mortality. Splenectomy was not associated with increased mortality. Discussion: Splenectomy in AIHA was associated with significant early thrombotic risk and long-term morbidity. Future research should evaluate the role of splenectomy in AIHA patients, and potential long-term thrombotic and antibiotic prophylaxis.
AB - Introduction: The impact of splenectomy on venous thrombosis (VTE), abdominal thrombosis (abVTE) and sepsis in autoimmune hemolytic anemia (AIHA) is unclear. Methods: Using the California Discharge Dataset 1991–2014, 4756 AIHA patients were identified. Cumulative incidences (CI) of VTE, abVTE, and sepsis were determined in patients with and without splenectomy. Using propensity score matching adjusted for competing risk of death, the association between VTE, abVTE and sepsis with splenectomy was determined. Results: In those without splenectomy, the CIs of VTE, abVTE, and sepsis were 1.4%, 0.2%, and 4.3% respectively, compared to 4.4%, 3.0% and 6.7% with splenectomy. Splenectomy was associated with increased risk for VTE in immediate (HR 2.66, CI 1.36–5.23) and late (HR 3.29, CI 2.10–5.16) post-operative periods. AbVTE was increased in immediate post-operative period (HR 34.11, CI 4.93–236.11). Sepsis was only increased in late post-operative period (HR 2.20, CI 1.75–2.77). In multivariate models, older age, having >1 comorbidity and having VTE, abVTE, and sepsis were associated with increased mortality. Splenectomy was not associated with increased mortality. Discussion: Splenectomy in AIHA was associated with significant early thrombotic risk and long-term morbidity. Future research should evaluate the role of splenectomy in AIHA patients, and potential long-term thrombotic and antibiotic prophylaxis.
KW - Autoimmune hemolytic anemia
KW - Sepsis
KW - Splenectomy
KW - Thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85075727443&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075727443&partnerID=8YFLogxK
U2 - 10.1016/j.bcmd.2019.102388
DO - 10.1016/j.bcmd.2019.102388
M3 - Article
AN - SCOPUS:85075727443
VL - 81
JO - Blood Cells, Molecules, and Diseases
JF - Blood Cells, Molecules, and Diseases
SN - 1079-9796
M1 - 102388
ER -