Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia

Gwendolyn Ho, Ann Brunson, Theresa H.M. Keegan, Ted Wun

Research output: Contribution to journalArticle

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 languageEnglish (US)
Article number102388
JournalBlood Cells, Molecules, and Diseases
Volume81
DOIs
StatePublished - Mar 2020

Fingerprint

Autoimmune Hemolytic Anemia
Venous Thromboembolism
Splenectomy
Sepsis
Incidence
Propensity Score
Antibiotic Prophylaxis
Mortality
Venous Thrombosis
Comorbidity
Thrombosis
Morbidity

Keywords

  • Autoimmune hemolytic anemia
  • Sepsis
  • Splenectomy
  • Thrombosis

ASJC Scopus subject areas

  • Molecular Medicine
  • Molecular Biology
  • Hematology
  • Cell Biology

Cite this

@article{a6d3a9cbe52943b199821f4c9c717f24,
title = "Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia",
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.",
keywords = "Autoimmune hemolytic anemia, Sepsis, Splenectomy, Thrombosis",
author = "Gwendolyn Ho and Ann Brunson and Keegan, {Theresa H.M.} and Ted Wun",
year = "2020",
month = "3",
doi = "10.1016/j.bcmd.2019.102388",
language = "English (US)",
volume = "81",
journal = "Blood Cells, Molecules, and Diseases",
issn = "1079-9796",
publisher = "Academic Press Inc.",

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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

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