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

ANZ J Surg. 2018 Oct;88(10):E725-E729. doi: 10.1111/ans.14395. Epub 2018 Feb 3.

Abstract

Background: This study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro-oesophageal devascularization.

Methods: We retrospectively analysed 139 patients who underwent splenectomy with gastro-oesophageal devascularization for portal hypertension due to cirrhosis between April 2010 and December 2016. Based on the post-operative platelet values, we used two different APT regimens: APT was started when platelet counts were increased to 200 × 109 /L or above (group A, n = 64) or 300 × 109 /L or above (group B, n = 75). We took note of the patients' clinical symptoms, operative factors and biochemical indicators.

Results: Platelet count, mean platelet volume, D-dimer and pancreatic fistula were closely related to the development of PVT. Early APT was an independent protective factor for PVT. The incidence of post-operative PVT was 15.1% (21/139) overall, 4.7% (3/64) in group A and 24% (18/75) in group B; there was a significant difference between groups A and B (χ2 = 10.042, P = 0.002).

Conclusion: Platelet count, mean platelet volume, D-dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastro-oesophageal devascularization. Selection of the appropriate timing for early APT according to the post-operative platelet count was feasible. Moreover, the use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT.

Keywords: antiplatelet therapy regimen; portal hypertension; portal vein hypertension; risk factors; splenectomy with gastro-oesophageal devascularization.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Hypertension, Portal / etiology
  • Hypertension, Portal / physiopathology
  • Hypertension, Portal / surgery*
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnostic imaging
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Portal Vein / pathology
  • Portal Vein / surgery
  • Postoperative Care / methods
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Splenectomy / adverse effects
  • Splenectomy / methods*
  • Treatment Outcome
  • Ultrasonography, Doppler, Color / methods
  • Vascular Surgical Procedures / methods*
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / drug therapy*
  • Venous Thrombosis / etiology
  • Young Adult

Substances

  • Platelet Aggregation Inhibitors