Trauma/Critical CareSplenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism
Section snippets
Study setting and selection of participants
This was a 14-month prospective, multicenter, observational study in which we examined the coagulation profile of trauma patients using serial thrombelastography values. The study was conducted at 3 American College of Surgeons−verified Level 1 trauma centers: The Texas Trauma Institute at Memorial Hermann Hospital (Houston, TX), San Francisco General Hospital (San Francisco, CA), and Oregon Health & Sciences University (Portland, OR). The Institutional Review Boards for all 3 hospitals and
Patient demographics, injury characteristics, and arrival laboratory and transfusion data
A total of 1,242 patients were enrolled in this multicenter study, in which we examined the coagulation profile of trauma patients by using serial thrombelastography values. A total of 795 patients had more than one rTEG value obtained, and these patients made up the population for all studies resulting from this prospective, observational study. Of these, 605 patients had serial rTEG values obtained after 24 hours and were the focus of the present study. This represents 76% of the overall
Discussion
Hypercoagulability after trauma has been reported in several previous studies; however, the exact mechanisms and significance remain poorly understood. In this multicenter, prospective study, we examined the role of splenectomy for trauma and its effect on coagulation profiles and TE risk over time. We found that patients undergoing splenectomy: 1) developed significantly greater platelet counts beginning at 72 hours; 2) developed more hypercoagulable alpha angle and MA values on rTEG beginning
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Cited by (37)
Aspirin Administration Mitigates Platelet Hyperaggregability After Splenectomy in a Murine Model
2022, Journal of Surgical ResearchCitation Excerpt :Pommerening et al. provided evidence that patients who underwent SPLN displayed faster clot formation within 24 h after traumatic injury and by 48 h exhibited stronger clots than traumatically injured patients without SPLN.25 These authors also noted a greater than three-fold risk of VTE in traumatically injured patients with SPLN than those who did not undergo SPLN.25 Similarly, Watters et al. found that traumatically injured patients with SPLN had faster fibrin cross-linking and enhanced fibrinolysis compared to non-SPLN patients at baseline and an elevated clot strength above normal values.26
Is simultaneous partial splenectomy during pediatric liver transplantation safe and effective for severe hypersplenism? A prospective cohort study
2021, International Journal of SurgeryCitation Excerpt :And no occurrence of infectious complications including OPSIs after partial splenectomy was observed in patients undergoing partial splenectomy during the whole follow-up period, which may be attributed to the preserved immune function of the remnant partial spleen. Notably, patients undergoing splenectomy have a more hypercoagulable state, and the risk of post-splenectomy thromboembolic complications is high not only in the immediate postoperative period but also in the long-term follow-up period [11,21]. Moreover, liver transplant recipients receiving vascular anastomosis are more likely to develop thromboembolic events after LT, which may complicate the postoperative course and even lead to increased patient or graft mortality.
Post-TBI splenectomy may exacerbate coagulopathy and platelet activation in a murine model
2020, Thrombosis ResearchRole of spleen and liver for enhanced hemostatic competence following administration of adrenaline to humans
2019, Thrombosis ResearchCitation Excerpt :The spleen encompasses approximately 30% of the platelet pool [20], and functions as a reservoir that empties during adrenergic stimulation [8,10]. The high baseline platelet count in the splenectomized subjects may reflect the missing reservoir for platelets and seems of clinical relevance as splenectomized subjects demonstrate increased risk of cardiovascular events and the elevated platelet count may be important in that regard [21–23]. The TEG analysis showed reduced R-time, increased α-angle and MA for the controls during infusion of adrenaline, i.e. adrenaline affected clot initiation and amplification/propagation.
Splenectomy protects aged mice from injury after experimental stroke
2018, Neurobiology of AgingCitation Excerpt :First, we investigated the effect of splenectomy at a relatively early time point (96 hours poststroke). Although removal of spleen resulted in reduced stroke injury, splenectomy itself has been shown to result in several complications including increased bacterial infections and thrombosis, which may occur at later time points (Lin et al., 2015; Pommerening et al., 2015). Second, in this study, we did not include female animals, as this study was conducted with the primary objective of evaluating the role of spleen in an aged stroke model to ensure that this was a viable target in an appropriate animal model.
This work was supported, in part, by a research grant from Haemonetics Corporation (Braintree, MA).