Chia Tze L, Chesney Tyler R, Isa David, Mnatzakanian Gevork, Colak Errol, Belmont Caio, Hirpara Dhruvin, Veigas Precilla V, Acuna Sergio A, Rizoli Sandro, Rezende-Neto Joao
Department of Medical Imaging, St. Michael's Hospital, Toronto, Canada.
Department of Surgery, University of Toronto, Toronto, Canada.
Injury. 2017 Jan;48(1):142-147. doi: 10.1016/j.injury.2016.07.016. Epub 2016 Jul 16.
Thrombocytosis is common following elective splenectomy and major trauma. However, little is known about the in-hospital course of platelet count (PC) and incidence of thrombocytosis after splenic trauma. Extreme thrombocytosis (PC>1000×10) is associated with increased risk of venous thromboembolism (VTE) in primary thrombocytosis leading to the use of acetylsalicylic acid (ASA) for risk reduction, but the need for this agent in splenic trauma is undefined.
Retrospective cohort study of all patients with splenic trauma between April 1, 2010 and March 31, 2014. The in-hospital course of PC was assessed based on splenic injury management type. The association of management type with thrombocytosis was evaluated using a multivariable logistic regression model adjusting for potential confounders. The association of thrombocytosis, extreme thrombocytosis, and ASA use for the outcome of VTE was explored.
156 patients were eligible, PC initially increased in all patients with the highest peak after total splenectomy. The incidence of thrombocytosis was 41.0% (64/156). Thrombocytosis was more likely following splenectomy compared with spleen preserving strategies independent of length of stay, injury grade, ISS, age and transfusion (OR 7.58, 95% CI: 2.26-25.45). Splenectomy was associated with extreme thrombocytosis (OR 10.39, 95% CI: 3.59-30.07).
Thrombocytosis in splenic trauma is more likely after splenectomy than with spleen preserving strategies. Splenectomy is associated with extreme thrombocytosis. There was insufficient data in our study to determine the use of ASA as primary prevention of VTE after splenic trauma.
血小板增多症在择期脾切除术后和严重创伤后很常见。然而，关于脾外伤后血小板计数（PC）的院内病程及血小板增多症的发生率知之甚少。在原发性血小板增多症中，极端血小板增多症（PC>1000×10⁹/L）与静脉血栓栓塞（VTE）风险增加相关，这导致使用阿司匹林（ASA）来降低风险，但脾外伤时使用该药物的必要性尚不明确。
对2010年4月1日至2014年3月31日期间所有脾外伤患者进行回顾性队列研究。根据脾损伤处理类型评估PC的院内病程。使用多变量逻辑回归模型评估处理类型与血小板增多症的关联，并对潜在混杂因素进行校正。探讨血小板增多症、极端血小板增多症以及使用ASA与VTE结局之间的关联。
156例患者符合条件，所有患者的PC最初均升高，全脾切除术后达到最高峰。血小板增多症的发生率为41.0%（64/156）。与保脾策略相比，脾切除术后更易发生血小板增多症，与住院时间、损伤分级、损伤严重度评分（ISS）、年龄及输血无关（比值比[OR]7.58，95%置信区间[CI]：2.26 - 25.45）。脾切除术与极端血小板增多症相关（OR 10.39，95% CI：3.59 - 30.07）。
脾外伤后，脾切除术后比保脾策略更易发生血小板增多症。脾切除术与极端血小板增多症相关。我们的研究中没有足够的数据来确定使用ASA作为脾外伤后VTE的一级预防措施。
