Recommended strategies to prevent early and late complications after splenectomy
| Complication . | Early . | Late . |
|---|---|---|
| Surgical morbidity | Careful patient selection: older patients and those with comorbidities are less attractive candidates for surgery and anesthesia. Alternative therapies should be considered. | |
| Bleeding | Laparoscopic splenectomy | |
| Elevation of platelets to >30 × 109/L to 50 × 109/L using steroids, IVIg (or TPO-RA if no response to these) | ||
| Infection | Vaccination against S pneumoniae, H influenzae type b, and N meningitidis, ideally at least 2 wk prior to surgery | Repeat vaccination against S pneumoniae every 5 y, annual influenza vaccine |
| Education about the risk of postsplenectomy sepsis. Emphasize need for early administration of antibiotics in case of fever. | Patients may be at higher risk of babesiosis and malaria and should be aware of this if traveling to endemic areas. | |
| Consider prophylactic antibiotics postoperatively. | ||
| Vascular complications | Early mobilization, hydration, and initiation of prophylactic anticoagulation once hemostasis has been ensured in patients with other risk factors for thrombosis | Address modifiable risk factors (smoking, obesity, etc.). |
| Early | Aspirin may be prescribed for patients with cardiovascular risk factors. | |
| Postoperative VTE including acute portal/splenic vein thrombosis | Thromboprophylaxis in the setting of elective surgery or other situations that increase thrombotic risk | |
| Late | ||
| VTE | ||
| Atherothrombotic events |
| Complication . | Early . | Late . |
|---|---|---|
| Surgical morbidity | Careful patient selection: older patients and those with comorbidities are less attractive candidates for surgery and anesthesia. Alternative therapies should be considered. | |
| Bleeding | Laparoscopic splenectomy | |
| Elevation of platelets to >30 × 109/L to 50 × 109/L using steroids, IVIg (or TPO-RA if no response to these) | ||
| Infection | Vaccination against S pneumoniae, H influenzae type b, and N meningitidis, ideally at least 2 wk prior to surgery | Repeat vaccination against S pneumoniae every 5 y, annual influenza vaccine |
| Education about the risk of postsplenectomy sepsis. Emphasize need for early administration of antibiotics in case of fever. | Patients may be at higher risk of babesiosis and malaria and should be aware of this if traveling to endemic areas. | |
| Consider prophylactic antibiotics postoperatively. | ||
| Vascular complications | Early mobilization, hydration, and initiation of prophylactic anticoagulation once hemostasis has been ensured in patients with other risk factors for thrombosis | Address modifiable risk factors (smoking, obesity, etc.). |
| Early | Aspirin may be prescribed for patients with cardiovascular risk factors. | |
| Postoperative VTE including acute portal/splenic vein thrombosis | Thromboprophylaxis in the setting of elective surgery or other situations that increase thrombotic risk | |
| Late | ||
| VTE | ||
| Atherothrombotic events |