Immune Thrombocytopenic Purpura Splenectomy in the Context of New Medical Therapies

Tarin Worrest, Aaron Cunningham, Elizabeth Dewey, Thomas Deloughery, Erin Gilbert, Brett Sheppard, Laura E. Fischer

Research output: Contribution to journalArticle

Abstract

Background: As medical therapy improves, splenectomy has been relegated to third- or fourth-line therapy for immune thrombocytopenic purpura (ITP) in many hematologic practices. However, these medications have well-known associated morbidity and changes in treatment algorithms may affect the timing and degree of response to splenectomy as well as complications in heavily treated ITP patients. Materials and methods: This is a retrospective study of consecutive patients who underwent ITP splenectomy from January 1994 to June 2017. Nonresponders after splenectomy and those with recurrent disease were compared to complete responders. Results: The cohort included 84 patients. Median number of medications received before splenectomy was 3 (1-6). 14.3% of patients had a medication-related complication, including heart failure, adrenal insufficiency, diabetes mellitus, infection, and osteoporosis. After splenectomy, 83.5% had a complete response, 7.5% partial response, and 9% no response. Complete response was associated with response to steroids before surgery (P < 0.01). Among responders, 19% had recurrent disease, which was associated with lower platelet count at diagnosis (P < 0.01). Forty-four patients (52.0%) had nonelective splenectomies for persistent bleeding or dangerously low platelets despite maximal medical therapy. Ten patients had Clavien-Dindo grade II or higher surgical complications (11.9%). Seven of these complications were related to recurrent or refractory ITP. Conclusions: Many ITP patients have complications related to medication use, and 52.0% required nonelective splenectomy despite maximal medical therapy. Earlier splenectomy may avoid medication-related complications and may reduce the complications from splenectomy. Splenectomy remains an effective and safe treatment for ITP.

Original languageEnglish (US)
Pages (from-to)643-648
Number of pages6
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

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Idiopathic Thrombocytopenic Purpura
Splenectomy
Therapeutics
Adrenal Insufficiency
Platelet Count
Osteoporosis
Diabetes Mellitus
Blood Platelets
Heart Failure
Retrospective Studies
Steroids
Hemorrhage
Morbidity

Keywords

  • Immune thrombocytopenic purpura
  • Splenectomy
  • Thrombocytopenia

ASJC Scopus subject areas

  • Surgery

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Immune Thrombocytopenic Purpura Splenectomy in the Context of New Medical Therapies. / Worrest, Tarin; Cunningham, Aaron; Dewey, Elizabeth; Deloughery, Thomas; Gilbert, Erin; Sheppard, Brett; Fischer, Laura E.

In: Journal of Surgical Research, Vol. 245, 01.01.2020, p. 643-648.

Research output: Contribution to journalArticle

Worrest, Tarin ; Cunningham, Aaron ; Dewey, Elizabeth ; Deloughery, Thomas ; Gilbert, Erin ; Sheppard, Brett ; Fischer, Laura E. / Immune Thrombocytopenic Purpura Splenectomy in the Context of New Medical Therapies. In: Journal of Surgical Research. 2020 ; Vol. 245. pp. 643-648.
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AU - Sheppard, Brett

AU - Fischer, Laura E.

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AB - Background: As medical therapy improves, splenectomy has been relegated to third- or fourth-line therapy for immune thrombocytopenic purpura (ITP) in many hematologic practices. However, these medications have well-known associated morbidity and changes in treatment algorithms may affect the timing and degree of response to splenectomy as well as complications in heavily treated ITP patients. Materials and methods: This is a retrospective study of consecutive patients who underwent ITP splenectomy from January 1994 to June 2017. Nonresponders after splenectomy and those with recurrent disease were compared to complete responders. Results: The cohort included 84 patients. Median number of medications received before splenectomy was 3 (1-6). 14.3% of patients had a medication-related complication, including heart failure, adrenal insufficiency, diabetes mellitus, infection, and osteoporosis. After splenectomy, 83.5% had a complete response, 7.5% partial response, and 9% no response. Complete response was associated with response to steroids before surgery (P < 0.01). Among responders, 19% had recurrent disease, which was associated with lower platelet count at diagnosis (P < 0.01). Forty-four patients (52.0%) had nonelective splenectomies for persistent bleeding or dangerously low platelets despite maximal medical therapy. Ten patients had Clavien-Dindo grade II or higher surgical complications (11.9%). Seven of these complications were related to recurrent or refractory ITP. Conclusions: Many ITP patients have complications related to medication use, and 52.0% required nonelective splenectomy despite maximal medical therapy. Earlier splenectomy may avoid medication-related complications and may reduce the complications from splenectomy. Splenectomy remains an effective and safe treatment for ITP.

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