Systemic thromboembolic complications after laparoscopic splenectomy for idiopathic thrombocytopenic purpura in comparison to open surgery in the absence of anticoagulant prophylaxis

Idiopathic thrombocytopenic purpura [ITP] in adults has a chronic course and may necessitate splenectomy. The current study was undertaken to study the systemic thromboembolic complications of laparoscopic splenectomy [LS] versus open splenectomy [OS] in patients with ITP at two large referral hospitals. We conducted a retrospective analysis of 49 patients who underwent splenectomy [21 LS and 28 OS] for primary/relapsing refractory ITP between June 1995 and November 2004. Clinically and/or radiologically confirmed deep venous thrombosis [DVT] and/or pulmonary embolism [PE] were assessed within 2 weeks before and after splenectomy. None had prophylactic anticoagulants immediately after surgery. Follow up of those who developed complications continued for at least 2 additional years to assess for contributing factors that may have been masked at the time of occurrence. Two [9.5%] LS group had acute PE within 5 days of LS and their platelet count reached 500 +/- 103/ micro L within 4 days and 1000 +/- 103/ micro L within 7 days after surgery. Three conversions to OS occurred; none had VTE. DVT occurred in 3 patients [10.7%] in the OS group; none were life threatening. There were no deaths. Life-threatening venous thromboembolic events are serious complications after LS and OS for ITP patients if prophylactic anticoagulants are not administered. Patients at risk are those who both have an exponential rise of the platelet count, although factors other than the platelet count may be contributing in OS. Postsplenectomy, ITP should be considered as a thrombophilic condition and studies of additional measures to prevent such events are warranted