Screening for Prothrombotic States Does Not Identify Patients at Risk for Portal and Splenic Vein Thrombus Following Laparoscopic Splenectomy

Namdar Manouchehri, Pepa Kaneva, Chantal Seguin, Giovanni P Artho, Gerald M Fried, Liane S Feldman. McGill University Health Centre.

Introduction The aim of this study is to identify specific acquired prothrombotic risk factors contributing to the development of portal or splenic vein thrombosis (PSVT) following laparoscopic splenectomy (LS). PSVT are potentially lethal complications of splenectomy. Known risk factors for PSVT include malignancy and splenomegaly. While these patients are believed to be hypercoagulable, the specific mechanism unclear.

Methods and Procedures Consecutive patients undergoing LS were prospectively studied between 2005 and 2013. Laboratory investigations were drawn preoperatively for screening of prothrombotic states including antithrombin III and Protein C and S deficiency, lupus anticoagulant, Factor V Leiden and Prothrombin 20210 mutations and elevation of Factor VIII levels. Surveillance duplex ultrasonography was performed between 1 week and 1 month postoperatively to assess for PSVT. The association between baseline prothrombotic disorders and PSVT was explored using descriptive statistics. Data are expressed as mean (95% CI) or median [IQR].

Results Of 77 patients enrolled in the study, 69 were included in the analysis and 17 (25%) of which developed PSVT. There were no differences in patients with and without PSVT with respect to age, body mass index, gender or surgical time. Preoperative spleen size, as determined by diagnostic imaging, was associated with PSVT; 7 of 8 patients (88%) with massive splenomegaly (>20 cm) developed PSVT compared with 3 of 11 patients (27%) with splenomegaly (15-20 cm) and 6 of 39 patients (15%) without (p < 0.001). Fifty-two patients (75%) demonstrated at least one abnormal prothrombotic screening test at baseline, with elevated Factor VIII levels the most common (55%). However, none of the identified prothrombotic factors were associated with the development of PSVT (see table).

Conclusion In patients scheduled for LS, screening for prothrombotic states is not useful to identify patients at risk for development of PSVT. In this study, only preoperative spleen size was predictive of PSVT formation.