Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

Vianelli, Nicola; Palandri, Francesca; Polverelli, Nicola; Stasi, Roberto; Joelsson, Joel; Johansson, Eva; Ruggeri, Marco; Zaja, Francesco; Cantoni, Silvia; Catucci, Angelo Emanuele; Candoni, Anna; Morra, Enrica; Björkholm, Magnus; Baccarani, Michele; Rodeghiero, Francesco

doi:10.3324/haematol.2012.075648

Cited by 110 publications

(137 citation statements)

References 28 publications

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“…41 Another prospective analysis of 114 patients with ITP refractory to splenectomy reported an increased rate of VTE compared with the expected rate of VTE in the general population; however, this increase was not significant when patients with other VTE risk factors were removed from the analysis. 23 In contrast, a more recent retrospective analysis of 233 patients with ITP who underwent splenectomy revealed an 8% incidence of VTE in the 10-year period of follow-up, 42 a higher incidence than previously reported and herein.…”

Section: Discussioncontrasting

confidence: 43%

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

Boyle¹,

White

Brunson³

et al. 2013

Blood

179

148

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• After splenectomy, patients with ITP have a higher risk of venous thrombosis and sepsis than patients with ITP who do not undergo splenectomy.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. (Blood. 2013;121(23):4782-4790)

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Section: Discussioncontrasting

confidence: 43%

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

Boyle¹,

White

Brunson³

et al. 2013

Blood

179

148

View full text Add to dashboard Cite

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“…In conclusion, there seems to be a slight increase of VTE in patients with chronic ITP, mainly modulated by age and general risk factors for thrombosis. There is a clear increase (three-to four-fold) of lifelong risk of VTE and AT in splenectomized patients [20,27] which was also evident in some retrospective single cohort studies [5,26]. Despite conflicting results, the presence of APA may represent an additional risk for venous and arterial thrombosis.…”

Section: Thrombotic Risk and Tpomentioning

confidence: 86%

“…From descriptive studies, the occurrence of thrombotic events has been estimated from 8% in a monocentric series of 233 splenectomized ITP patients with a minimum follow-up of 10 years [26] to 50% in Aledort et al [11]. In another retrospective study on 105 patients unresponsive to splenectomy, 12% developed a thrombotic event during a median follow-up of 110 months [5].…”

Section: Th Anniversary Issuementioning

confidence: 99%

Is ITP a thrombophilic disorder?

2015

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Immune thrombocytopenia (ITP) represents the epitome of acquired bleeding diseases for the hematologist. Stemming from the interest for the safety of thrombopoietin‐receptor agonists (TPO‐ra) romiplostim and eltrombopag, recent data have investigated if thrombotic risk is also increased in this disorder. In patients not treated with TPO‐ra, a slightly higher risk of venous thrombosis (VTE) is consistently found in ITP, but not to a rate demanding special attention in the generality of cases. No significant increase of arterial thrombosis (AT) is apparent. However, age, splenectomy, and personal risk factors may put some ITP patient to a particularly higher risk of venous and arterial thrombosis (three to four times higher than the average subject). Patients exposed to TPO‐ra present indirect evidence of a much higher risk of both AT and VTE. Unfortunately, no matched control population is available and the prospective and registrative nature of these studies may have emphasized the incidence of thrombosis, which was recorded as adverse event. The clinician should be able to individualize the best treatment for the patient, taking also into account the thrombotic risk, limiting active treatment of ITP to those patients really at risk of bleeding. Am. J. Hematol. 91:39–45, 2016. © 2015 Wiley Periodicals, Inc.

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“…According to the hypothesis, this mechanism may predict for failure to respond to splenectomy, a recognized highly effective ITP treatment. 4 To date, however, this hypothesis has not been tested in ITP patients.…”

mentioning

confidence: 99%

Clinical relevance of antiplatelet antibodies and the hepatic clearance of platelets in patients with immune thrombocytopenia

Cantoni

Carpenedo

Nichelatti³

et al. 2016

Blood

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Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

Cited by 110 publications

References 28 publications

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

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

Is ITP a thrombophilic disorder?

Clinical relevance of antiplatelet antibodies and the hepatic clearance of platelets in patients with immune thrombocytopenia

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