Predictive factors of portal vein thrombus following splenectomy in patients with severe cirrhosis.

BACKGROUND/AIMS: Splenectomy is performed in patients with severe cirrhosis who have a low platelet count. A portal vein thrombus (PVT) is one of the complications associated with splenectomy. This study aimed to identify predictive factors of postoperative PVT following splenectomy.

METHODOLOGY

Twentyeight patients who underwent splenectomy between April 2003 and March 2013 were retrospectively analyzed. Patients were divided into two groups: the PVT(+) group comprising 11 patients who developed postoperative PVT, and the PVT(-) group comprising 17 patients who did not develop postoperative PVT. The patient characteristics of the 2 groups were analyzed. Results: In univariate analysis, the platelet count, rate of simultaneous treatment of hepatocellular carcinoma, and preoperative spleen volume were significantly different between the groups (p < 0.05). In multivariate analysis, preoperative spleen volume alone was an independent factor associated with the development of PVT (p = 0.007). At a preoperative spleen volume cutoff of 450 mL, the sensitivity and specificity were 90% and 73%, respectively.

CONCLUSIONS

In patients with severe cirrhosis scheduled to undergo splenectomy, if the preoperative spleen volume is >450 mL, as measured by enhanced computed tomography, preventive administration of anticoagulant therapy is recommended to reduce the risk of PVT development.