Total splenic vein thrombosis after laparoscopic splenectomy: a possible candidate for treatment

Ikeda, Masataka; Sekimoto, Mitsugu; Takiguchi, Shuji; Yasui, Masayoshi; Danno, Katsuki; Fujie, Yujiro; Kitani, Kotaro; Seki, Yosuke; Hata, Taishi; Shingai, Tatsushi; Takemasa, Ichiro; Ikenaga, Masakazu; Yamamoto, Hirofumi; Ohue, Masayuki; Monden, Morito

doi:10.1016/j.amjsurg.2006.06.036

Cited by 59 publications

(55 citation statements)

References 22 publications

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“…The highest incidence (19.0%, 22.5% and 51.5%) was reported in the two prospective studies with CT monitoring 8,17 and in one prospective study with color Doppler imaging at multiple time points. 12 In the CT studies small, often multiple thromboses (or emboli?)…”

Section: Resultsmentioning

confidence: 91%

“…12,13,16,17,18 Contrast-enhanced computerized tomography (CT) was used by two studies of the same authors 8,17 and color Doppler imaging in the remaining studies. The time schedule for monitoring was not identical in these series and ranged from one single examination between days 3 and 11 8,17 to two or more examinations (days 7, 30 and later). 9,11,12 The patients were extremely heterogeneous with regard to the underlying diseases.…”

Section: Resultsmentioning

confidence: 99%

“…39 In fact, the incidence of SPVT was at least twice as high when contrastenhanced CT was used for screening or diagnosis. 8,17 Another explanation for the above-mentioned discrepancies may be the time points of screening, which were quite variable. 9,[11][12][13]15 The definition of risk factors is important for the choice of intensity and duration of postoperative antithrombotic prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…The median time from splenectomy to asymptomatic SPVT was six days (range 3-11 days) in a study with contrast-enhanced CT. 17 The median interval between splenectomy and symptomatic SPVT in three retrospective studies was 10.7 (range 4-27) days, 24 11.6 days (range 2-22) 5 and 12 days (range 6-99), 21 while it was eight days (range 2->28) in published reports on single or small series of cases in which data on the interval between splenectomy and SPVT were provided ( Figure 1). Considering all data, we infer that the latency period from the onset of thrombosis to clinical symptoms is on average one week or more.…”

Section: Time From Surgery To Asymptomatic or Symptomatic Splenic/pormentioning

confidence: 99%

“…In the majority of cases in whom a follow-up investigation was performed (n=90) 5,9,11,12,[15][16][17][20][21][23][24][25]28,33 there was a documented complete (57/90, 63.3%) or at least partial resolution (13.3 %) of the thrombus. However, in 7.7% the thrombus persisted and in 15.5% cavernoma or portal hypertension were documented.…”

Section: Response To Treatment and Late Complicationsmentioning

confidence: 99%

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The postoperative splenic/portal vein thrombosis after splenectomy and its prevention - an unresolved issue

Krauth¹,

Lechner²,

Neugebauer³

et al. 2008

Haematologica

121

103

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Patients undergoing splenectomy have an increased risk of splenic/portal vein thrombosis. We used several databases to identify publications dealing with this risk and analyzed incidence, risk factors and outcome. The risk of splenic portal vein thrombosis has been addressed in prospective and retrospective randomized or non-randomized studies. All studies combined, the overall risk is 3.3%. Risk factors are big spleens (i.e. myeloproliferative disorders) and hereditary hemolytic anemias, whereas the risk is low in autoimmune thrombocytopenia and trauma. The incidence is approximately the same in laparascopic and open splenectomy. The median time from splenectomy to symptomatic splenic vein thrombosis is 8-12 days. Postoperative antithrombotic prophylaxis ranged from no prophylaxis to heparin for seven days or longer. Treatment of symptomatic splenic vein thrombosis with heparin and warfarin leads to complete resolution of thrombosis in 67%, to partial resolution in 13%, but persistent occlusion, portal hypertension or cavernoma occurred in 20%. The long-term outcome of treatment failures is unknown. Well-designed randomized studies on the prophylaxis of venous thromboembolism after splenectomy are urgently needed.Key words: portal vein thrombosis, risk factors, splenectomy, thromboembolism, treatment. Citation: Krauth M-T, Lechner K, Neugebauer EAM and Pabinger I. The postoperative splenic/portal vein thrombosis after splenectomy and its prevention -an unresolved issue.

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Section: Resultsmentioning

confidence: 91%