Splenectomy leads to a persistent hypercoagulable state after trauma.

Autor: Watters JM; Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, Portland, OR, USA. wattersj@ohsu.edu, Sambasivan CN, Zink K, Kremenevskiy I, Englehart MS, Underwood SJ, Schreiber MA
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2010 May; Vol. 199 (5), pp. 646-51.
DOI: 10.1016/j.amjsurg.2010.01.015
Abstrakt: Background: It was hypothesized that splenectomy following trauma results in hypercoagulability.
Methods: A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury.
Results: Patients with splenectomy (n = 30) and nonoperative management (n = 50) were enrolled. Splenectomy patients were older, had higher Injury Severity Scores, and had longer intensive care unit and hospital stays (P < .05). Splenectomy patients had significantly increased white blood cell counts and platelet counts at baseline and follow-up (P < .01). Fibrinogen was initially elevated in both groups and remained elevated in the splenectomy group (P < .05). Tissue plasminogen activator, plasminogen activator inhibitor-1, and activated partial thromboplastin time were higher in splenectomy patients only at baseline (P < .05). Baseline thromboelastography showed faster fibrin cross-linking and enhanced fibrinolysis following splenectomy (P < .05). Only clot strength was greater at follow-up in the splenectomy group (P < .01). Deep venous thrombosis developed in 7% of splenectomy patients and no control patients (P = .03).
Conclusions: A significant difference in deep venous thrombosis formation was noted, and coagulation assays indicated persistent hypercoagulability following splenectomy for trauma.
(Copyright 2010 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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