Pharmacologic Prophylaxis of Portal Venous System Thrombosis after Splenectomy: A Meta-Analysis

Abstract

Portal venous system thrombosis (PVST) is a life-threatening complication of splenectomy. A meta-analysis was conducted to explore the role of pharmacologic prophylaxis of PVST after splenectomy. Overall, 359 papers were initially identified via the PubMed, EMBASE, and Cochrane Library databases. Eight of them were eligible. The incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.22–0.47, P < 0.00001). Subgroup analyses demonstrated that the significant difference remained in studies including patients with portal hypertension (n = 6), but not in those including patients with hematological diseases (n = 2); the significant difference remained in studies using any type of prophylactic drugs (anticoagulants [n = 6], thrombolytics [n = 1], and prostaglandin E1 [n = 1]); the significant difference remained in nonrandomized studies (n = 5), but not in randomized studies (n = 3). The risk of bleeding was similar between the two groups (OR: 0.65, 95% CI: 0.10–4.04, P = 0.64). In conclusion, pharmacologic prophylaxis might decrease the incidence of PVST after splenectomy in patients with portal hypertension and did not increase the risk of bleeding. However, the effect of pharmacologic prophylaxis of PVST in patients with hematological diseases remained questioned.

Effects of early antiplatelet therapy after splenectomy with gastro‐oesophageal devascularization

“…Splenomegaly is considered a risk factor for PVT after splenectomy with gastro‐oesophageal devascularization . PVT has been reported to potentially lead to severe clinical adverse events or poor outcomes .…”

“…Splenomegaly is considered a risk factor for PVT after splenectomy with gastro-oesophageal devascularization. 6 PVT has been reported to potentially lead to severe clinical adverse events or poor outcomes. 7 Regrettably, the mechanism underlying PVT formation remains unclear, and the prophylactic application of anticoagulants is controversial because of the concerns about the risk of bleeding.…”

Assessment the Effect of Prophylaxis Therapy on Splenic and Portal Vein Thrombosis after Open Splenectomy: A Controlled Randomized Clinical Trial

“…Clinical signs of SPVT include portal vein hypertension as esophageal varices, upper gastrointestinal bleeding (UGIB) and hypersplenism and intestinal ischemia (Janssen et al, 2001). The risk factors for SPVT include lymphoma, lymphoproliferative disorder, hemolytic anemia associated with splenomegaly (more than 650 grams), splenic vein diameter greater than 8 mm and hyper-coagulopathy (Qi, Bai, Guo, & Fan, 2014;Schettino, Fagundes, Roquete, Ferreira, & Penna, 2006). In addition, high possibility of SPVT can be seen in laparoscopic splenectomy.…”

“…Chemoprophylaxis may help to reduce the incidence of SPVT after splenectomy and thereby reducing complications (Qi et al, 2014). The routine anticoagulants after splenectomy have not been yet standardized.…”

“…European clinical practice guidelines propose the use of SC heparin as prophylaxis in all patients, unlike the new surgical guidelines (Wang et al, 2011). However, low-dose fondaparinux has been proposed for patients with high-risk LMWH (Low molecular weight heparins) (Wang et al, 2011;Qi et al, 2014). There are underpowered studies to determine the role of prophylaxis in preventing SPVT after splenectomy (Wang et al, 2011).…”