Splenic Artery Angioembolization is Associated with Increased Venous Thromboembolism

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Critical Care Medicine

Background:

• Splenic preservation after trauma is increasingly achieved with angioembolization.
• Splenic artery embolization may induce a transient hypercoagulable state.
• The risk of venous thromboembolism (VTE) following splenic angioembolization requires further investigation.

Purpose of the Study:

• To determine the risk of VTE in blunt trauma patients managed nonoperatively with splenic angioembolization.
• To compare VTE rates in patients who underwent splenic angioembolization versus those who did not.
• To identify risk factors for VTE in this patient population.

Main Methods:

• Retrospective review of the American College of Surgeons Trauma Quality Improvement Performance (TQIP) Database (2013-2016).
• Included adult patients (>16 years) with isolated, severe (Grades III-V) blunt splenic injuries managed nonoperatively receiving pharmacological VTE prophylaxis.
• Outcomes assessed included deep venous thrombosis (DVT), pulmonary embolism (PE), and any VTE.

Main Results:

• Angioembolization was associated with a higher incidence of DVT (4.5% vs. 1.4%, p<0.001).
• Multivariable analysis identified angioembolization as an independent risk factor for DVT (OR 2.65) and any VTE (OR 2.04).
• Delayed VTE prophylaxis (initiated >48 hours post-admission) increased VTE rates (OR 1.75, p=0.02).

Conclusions:

• Splenic artery angioembolization may be an independent risk factor for VTE in severe blunt splenic trauma.
• Early pharmacological VTE prophylaxis, particularly with low-molecular-weight heparin (LMWH), should be strongly considered after splenic angioembolization.
• Optimizing VTE prophylaxis timing is crucial in nonoperatively managed blunt splenic trauma patients.