Splenectomy in autoimmune hemolytic anemia (AIHA) may be associated with signiﬁcant early thrombotic risk and long-term morbidity, according to research published in Blood Cells, Molecules, and Diseases.
Researchers noted that the effect of splenectomy on venous thrombosis (VTE), abdominal thrombosis, and sepsis in patients with AIHA has not been fully investigated. Using the California Discharge Dataset 1991-2014, the researchers identified 4756 patients with AIHA with and without splenectomy and analyzed the cumulative incidences of VTE, abdominal thrombosis, and sepsis in the cohort.
The cumulative incidence of VTE was 1.4% in patients without splenectomy, compared with 4.4% in patients with splenectomy. The rate of abdominal thrombosis was 0.2% in patients without splenectomy and 3.0% in patients with splenectomy. The rate of sepsis was 4.3% in patients without splenectomy and 6.7% in patients with splenectomy.
Splenectomy was associated with increased risk for VTE in both the immediate postoperative period (hazard ratio [HR], 2.66; 95% CI, 1.36-5.23) and the late postoperative period (HR, 3.29; 95% CI, 2.10-5.16). In the immediate postoperative period, splenectomy was also associated with an increase in abdominal thrombosis (HR, 34.11; 95% CI; 4.93-236.11). Risk for sepsis was found to be increased in the late postoperative period (HR, 2.20; 95% CI, 1.75-2.77). In multivariate models, older age, having more than 1 comorbidity, and having VTE, abdominal thrombosis, or sepsis were all associated with increased mortality.
In hospitalized patients, subsequent splenectomy was associated with increased risk for VTE in both the immediate and late postoperative periods after adjusting for baseline characteristics and the competing risk of death. The researchers noted that prophylactic anticoagulation may be justiﬁed in this patient population.
- Ho G, Brunson A, Keegan THM, Wun T. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia. Blood Cells Mol Dis. 2020;81:102388.