Fatal venous thromboembolism after splenectomy: pathogenesis and management

Venous thromboembolism (VTE) occurs in approximately 10% of patients after splenectomy, particularly splenectomy performed for hematologic abnormalities. Clinicians often fail to recognize this potential complication in the postoperative period, leading to inappropriate anticoagulation prophylaxis and treatment for these patients. The authors discuss the pathophysiologic mechanisms of VTE in patients who undergo splenectomy and offer management strategies for this complication. A case report of a patient who underwent splenectomy for idiopathic thrombocytopenia purpura, with subsequent fatal VTE, highlights the importance of this issue. The authors also review current guidelines for managing venous thromboprophylaxis in patients who undergo general, laparoscopic, and cancer-related surgical procedures, and they compare these patients to those who undergo splenectomy.